Provider Demographics
NPI:1255495255
Name:NYE, GARY A (RPA-C)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:NYE
Suffix:
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:84 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-2608
Mailing Address - Country:US
Mailing Address - Phone:518-891-7155
Mailing Address - Fax:518-523-7577
Practice Address - Street 1:2233 STATE ROUTE 86
Practice Address - Street 2:ADIRONDACK MEDICAL CENTER
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-891-4141
Practice Address - Fax:518-891-7044
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY002893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS33891Medicare UPIN