Provider Demographics
NPI:1952430837
Name:WHITTIER, GARY E (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:WHITTIER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24818 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1837
Mailing Address - Country:US
Mailing Address - Phone:718-347-7621
Mailing Address - Fax:718-347-4796
Practice Address - Street 1:24818 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1837
Practice Address - Country:US
Practice Address - Phone:718-347-7621
Practice Address - Fax:718-347-4796
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY04440-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01138669Medicaid
NY01138669Medicaid
NY31075Medicare PIN
NYP46241Medicare PIN