Provider Demographics
NPI:1952414658
Name:GANCHER, PAUL DAVID (AUD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:GANCHER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16A DIX AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3162
Mailing Address - Country:US
Mailing Address - Phone:518-793-6480
Mailing Address - Fax:
Practice Address - Street 1:16A DIX AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3162
Practice Address - Country:US
Practice Address - Phone:518-793-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000097-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000412014001OtherBLUE SHIED OF NENY
NYM0202OtherEMPIRE BC/BS
NY6271OtherMVP
NY00989193Medicaid
NYM0202OtherBC/BS OF NENY
NY0030500OtherEMPIRE PLAN
NY10000729OtherCDPHP
NY51176BMedicare ID - Type Unspecified