Healthcare Provider Details

I. General information

NPI: 1326026220
Provider Name (Legal Business Name): GINA A TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE BOX 46
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

324 14TH ST #1
BROOKLYN NY
11215-5010
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number250930-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: