Healthcare Provider Details

I. General information

NPI: 1538302179
Provider Name (Legal Business Name): DR. GULLE AWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 E TREMONT AVE
BRONX NY
10460-4206
US

IV. Provider business mailing address

861 E TREMONT AVE
BRONX NY
10460-4206
US

V. Phone/Fax

Practice location:
  • Phone: 718-731-0704
  • Fax: 718-865-4291
Mailing address:
  • Phone: 718-731-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number250584
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number250584
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: