Active NPI
Gary Gasper Difatta, D.C.
- Chiropractor
- Lindenhurst, NY
National Provider Identifier
1043391592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- X06832-1
- Practice address
- 113 A South Wellwood Avenue
Lindenhurst, NY 11757 - Phone
- (631) 225-7630
- Fax
- (631) 225-7653
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | X06832-1 | NY | Primary |
Addresses
Primary practice location
113 A South Wellwood Avenue
Lindenhurst, NY 11757
Mailing address
113 A South Wellwood Avenue
Lindenhurst, NY 11757
Phone (631) 225-7630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11-3168353 | Other | NY | TAX ID |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006832 | NY | MD | Mental Health Counselor |
| X06832-1 | NY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043391592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 A SOUTH WELLWOOD AVENUE",
"city": "LINDENHURST",
"state": "NY",
"postal_code": "11757",
"telephone_number": "631-225-7630",
"fax_number": "631-225-7653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 A SOUTH WELLWOOD AVENUE",
"city": "LINDENHURST",
"state": "NY",
"postal_code": "11757",
"telephone_number": "631-225-7630",
"fax_number": "631-225-7653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIFATTA",
"first_name": "GARY",
"middle_name": "GASPER",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NY",
"license": "X06832-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "11-3168353",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lindenhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.