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NPI Code Detail

MEDICARE: ANGELIQUE GILLETTE

MEDICARE: ANGELIQUE GILLETTE
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
1224Z00000XOccupational Therapy Assistant5941NY

General Provider Information

NPI Number : 1265948541
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELIQUE GILLETTE
Provider Business Mailing Address
First Line : 4627 206TH ST
Second Line :
City : BAYSIDE
State : NY
Zip : 11361-3162
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3911 AVENUE P
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-3501
Country : US
Telephone Number : 718-377-5000
Fax Number : 718-377-5002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2017
Last Update Date : 12/21/2017

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Directions to “ ANGELIQUE GILLETTE ” Practice Location

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