Michael Gumuka, MD
Individual provider Active NPI Family Medicine Physician · Glens Falls, NY
NPI 1124345673 · NPPES record last updated Feb 7, 2017
Key facts
- NPI
- 1124345673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 269376 (NY)
- Practice address
- 100 Broad St
Glens Falls, NY 12801-4349 - Phone
- (518) 792-2223
- Fax
- (518) 792-8231
- NPI assigned
- Apr 23, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131112001630 | NY | Practitioner - Family Practice | 2769618248 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 269376 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Irongate Family Practice Associates PLLC | Family Medicine | Current |
Accepting new patients |
| Adirondack Radiology Associates, P.C. | Past | Accepting new patients |
Locations
3 Irongate Ctr
Glens Falls, NY 12801
Phone (518) 793-4409
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 269376 | NY | Yes |
Addresses
Primary practice location
100 Broad St
Glens Falls, NY 12801-4349
Mailing address
9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03648377 | Medicaid | NY |
Other providers in Glens Falls, NY
- Deidre Cottrell Grieve
- Heather Lee Grieves
- Therese Mary Griffin
- Kristin J. Grund
- Brian Guadagno
- Amanda Gustafson
- Courtney Hafner
- Darlene Hafner
- Kelley Haggerty
- Robert W Hahm
All providers in Glens Falls, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.