Provider Demographics
NPI:1851599047
Name:GATEWAY DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:GATEWAY DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VERRAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-745-5280
Mailing Address - Street 1:1 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3304
Mailing Address - Country:US
Mailing Address - Phone:518-745-5280
Mailing Address - Fax:518-745-5284
Practice Address - Street 1:1 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3304
Practice Address - Country:US
Practice Address - Phone:518-745-5280
Practice Address - Fax:518-745-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243122261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty