Nycholle Lynne Gavilanes, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

263634 Issued in NY

Practice address

8 Technology Drive
Suite 104
East Setauket, NY 11733

Phone

(516) 704-7447

Fax

(516) 734-6312

NPI assigned

May 6, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cogent Medical Care PC

  • Internal Medicine Physician
  • East Patchogue, NY
  • NPI 1912941238
  Medicare reassignment NPD
• Shahzad Iqbal Physician PLLC

  • Gastroenterology Physician
  • Queens Village, NY
  • NPI 1316331168
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1699941971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 TECHNOLOGY DRIVE",
            "address_2": "SUITE 104",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "11733",
            "telephone_number": "516-704-7447",
            "fax_number": "516-734-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 TECHNOLOGY DRIVE",
            "address_2": "SUITE 104",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "11733",
            "telephone_number": "516-704-7447",
            "fax_number": "516-734-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVILANES",
        "first_name": "NYCHOLLE",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-06",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "263634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ruane Garduno, M.D.
• David John Garry, DO
• Joseph Gartner, MD
• Gathman Spirito Physical Therapy
• Grace N Gathungu, MD
• Sharon Geiman
• Marie Gelato, M.D.
• Mark A Gelfand, MD
• Alyssa Rose Genduso
• General Surgery Associates LLC

• Internal Medicine Physician in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.