Provider Demographics
NPI:1821447210
Name:DUMALAOS, GERALD ACEJO (RN)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ACEJO
Last Name:DUMALAOS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24457 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1505
Mailing Address - Country:US
Mailing Address - Phone:516-713-7022
Mailing Address - Fax:
Practice Address - Street 1:24457 90TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1505
Practice Address - Country:US
Practice Address - Phone:516-713-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693487163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse