Healthcare Provider Details

I. General information

NPI: 1225243744
Provider Name (Legal Business Name): BARBARA GILLIES DEUTSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CROYDEN AVE
GREAT NECK NY
11023-1731
US

IV. Provider business mailing address

111 CROYDEN AVE
GREAT NECK NY
11023-1731
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-4250
  • Fax: 516-466-2842
Mailing address:
  • Phone: 516-466-4250
  • Fax: 516-466-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number095907-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: