Provider Demographics
NPI:1023273380
Name:ANCHETA, GERALD ABRAHAM (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ABRAHAM
Last Name:ANCHETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1627
Mailing Address - Country:US
Mailing Address - Phone:845-358-5006
Mailing Address - Fax:845-358-4340
Practice Address - Street 1:311 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1627
Practice Address - Country:US
Practice Address - Phone:845-358-5006
Practice Address - Fax:845-358-4340
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247141-1207R00000X
NY247141207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03132643Medicaid
NYA300027192OtherMEDICARE PTAN