Healthcare Provider Details

I. General information

NPI: 1508810441
Provider Name (Legal Business Name): GISELLE DE ANDRADE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 7TH AVE STE 302
NEW YORK NY
10019-5230
US

IV. Provider business mailing address

850 7TH AVE STE 302
NEW YORK NY
10019-5230
US

V. Phone/Fax

Practice location:
  • Phone: 212-757-9754
  • Fax: 646-688-4765
Mailing address:
  • Phone: 212-757-9754
  • Fax: 646-688-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00644900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number009468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: