MEDICARE: MS. DOROTHY MARIE GILLON M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	025584-0	NY

General Provider Information

NPI Number	:	1255571378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHY MARIE GILLON M.P.T.

Provider Business Mailing Address
First Line	:	303 59TH ST
Second Line	:
City	:	OCEAN CITY
State	:	NJ
Zip	:	08226-1019
Country	:	US
Telephone Number	:	718-312-9565
Fax Number	:

Provider Business Practice Location Address
First Line	:	277 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1003
Country	:	US
Telephone Number	:	718-312-9565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

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