Healthcare Provider Details

I. General information

NPI: 1295096881
Provider Name (Legal Business Name): G S GILL, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 STEWART AVE SUITE 101
GARDEN CITY NY
11530-4892
US

IV. Provider business mailing address

1101 STEWART AVE SUITE 101
GARDEN CITY NY
11530-4808
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-0055
  • Fax:
Mailing address:
  • Phone: 516-741-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number182198
License Number StateNY

VIII. Authorized Official

Name: DR. GURMIT S GILL
Title or Position: DIRECTOR
Credential: M.D.
Phone: 516-741-0055