Provider Demographics
NPI:1801898978
Name:POVILL, GARY I (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:I
Last Name:POVILL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:600 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2281
Mailing Address - Country:US
Mailing Address - Phone:845-231-5600
Mailing Address - Fax:845-231-5489
Practice Address - Street 1:1561 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5410
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:845-231-5489
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2014-09-24
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Provider Licenses
StateLicense IDTaxonomies
NY120418207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400044793Medicare PIN