Healthcare Provider Details

I. General information

NPI: 1649809773
Provider Name (Legal Business Name): DANIELLE MARIE GILLARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE AVE
BRONX NY
10467-2404
US

IV. Provider business mailing address

3400 BAINBRIDGE AVE
BRONX NY
10467-2404
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-9014
  • Fax: 718-405-9014
Mailing address:
  • Phone: 718-405-9014
  • Fax: 718-405-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.153711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: