Individual
DR. EDISON GENARO GAVILANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
317 BROADWAY STE A, AMITYVILLE, NY 11701-2770
(631) 598-5864
Mailing address
56-45 MAIN STREET, FLUSHING, NY 11355
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
257788
NY
207RP1001X
Pulmonary Disease Physician
Primary
257788
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/01/2008
Last updated
04/05/2020
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