Provider Demographics
NPI:1770691305
Name:FALOTICO, GERARD M (CRNA)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:M
Last Name:FALOTICO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 EAST STATE STREET
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE, NY 12078
Mailing Address - State:NY
Mailing Address - Zip Code:12078
Mailing Address - Country:US
Mailing Address - Phone:518-773-4205
Mailing Address - Fax:518-775-4225
Practice Address - Street 1:99 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE, NY 12078
Practice Address - State:NY
Practice Address - Zip Code:12078
Practice Address - Country:US
Practice Address - Phone:518-775-4205
Practice Address - Fax:518-775-4225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA0989Medicare ID - Type Unspecified
NYR54490Medicare UPIN