Provider Demographics
NPI:1902988561
Name:HAUSLER, GERALD JAY (DO)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:JAY
Last Name:HAUSLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 COVINGTON COURT
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-377-6555
Mailing Address - Fax:518-783-5426
Practice Address - Street 1:8 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2193
Practice Address - Country:US
Practice Address - Phone:518-783-7173
Practice Address - Fax:518-783-5426
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1356241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
922424OtherMVP HEALTH PLAN
9X6212OtherEMPIRE
10010052OtherCAP DIST PHYS HLTH PLAN
000497195003OtherBLUE SHIELD OF NE NY
5976497OtherAETNA
43694OtherGHIHMO
922424OtherMVP HEALTH PLAN
AA0636Medicare ID - Type Unspecified