Active NPI
Gary N Engle, PA
- Physician Assistant
- Lyons Falls, NY
National Provider Identifier
1023026549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000714
- Practice address
- 3926 State Route 12
Lyons Falls, NY 13368 - Phone
- (315) 346-6824
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000714 | NY | Primary |
Addresses
Primary practice location
3926 State Route 12
Lyons Falls, NY 13368
Mailing address
PO Box 2337
Syracuse, NY 13220-2337
Phone (315) 422-2933
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01941560 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 714 | NY | MD | Acupuncturist |
| 000714 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299801600000",
"number": "1023026549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2337",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132202337",
"telephone_number": "315-422-2933",
"fax_number": "315-422-3909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3926 STATE ROUTE 12",
"city": "LYONS FALLS",
"state": "NY",
"postal_code": "13368",
"telephone_number": "315-346-6824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENGLE",
"first_name": "GARY",
"middle_name": "N",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2011-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "000714",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01941560",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lyons Falls, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.