Provider Demographics
NPI:1780714204
Name:GARY S MEDOWS PC
Entity type:Organization
Organization Name:GARY S MEDOWS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEDOWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-260-5990
Mailing Address - Street 1:550 G GRAND ST
Mailing Address - Street 2:SUITE GF
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10002
Mailing Address - Country:US
Mailing Address - Phone:212-260-5990
Mailing Address - Fax:
Practice Address - Street 1:550 G GRAND ST
Practice Address - Street 2:SUITE GF
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-260-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P412791OtherOX
0059117OtherGHI
2C 6307OtherPHS
56411OtherUNITED
GM08391210OtherBS
098843OtherHIP
5353537004OtherCIGNA
098843OtherHIP
56411OtherUNITED