Provider Demographics
NPI:1356412472
Name:HANFLING, GARY B (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:HANFLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MANORHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1627
Mailing Address - Country:US
Mailing Address - Phone:516-496-4466
Mailing Address - Fax:516-883-7474
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:SUITE 101
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-496-4466
Practice Address - Fax:516-496-3965
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845890Medicaid
NY10D231Medicare PIN
NY00845890Medicaid
NYA99758Medicare UPIN