Individual
GREGORY GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4401 FRANCIS LEWIS BLVD, BAYSIDE, NY 11361-3002
(718) 423-3355
(718) 423-3721
Mailing address
4401 FRANCIS LEWIS BLVD, BAYSIDE, NY 11361-3002
(718) 423-3355
(718) 423-3721
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
138877
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00827358
—
NY
Enumeration date
07/18/2005
Last updated
05/03/2011
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