Provider Demographics
NPI:1922097302
Name:GILLIAR, WOLFGANG G (DO)
Entity Type:Individual
Prefix:DR
First Name:WOLFGANG
Middle Name:G
Last Name:GILLIAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHERN BLVD
Mailing Address - Street 2:ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-8000
Mailing Address - Country:US
Mailing Address - Phone:516-686-1300
Mailing Address - Fax:516-686-7890
Practice Address - Street 1:NORTHERN BLVD
Practice Address - Street 2:ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-8000
Practice Address - Country:US
Practice Address - Phone:516-686-1300
Practice Address - Fax:516-686-7890
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2337011208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1922097302OtherNPI NUMBER
NY1821048612OtherNPI GROUP NUMBER
NY1821048612OtherNPI GROUP NUMBER
NYE62161Medicare UPIN