Provider Demographics
NPI:1922190636
Name:GARDINER, JAMES G (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:GARDINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:427 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1742
Mailing Address - Country:US
Mailing Address - Phone:845-794-7741
Mailing Address - Fax:845-794-0228
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1742
Practice Address - Country:US
Practice Address - Phone:845-794-7741
Practice Address - Fax:845-794-0228
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN004633213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01158754Medicaid
NY0675350001Medicare NSC
P50871Medicare ID - Type Unspecified
NY01158754Medicaid