Healthcare Provider Details

I. General information

NPI: 1962571893
Provider Name (Legal Business Name): NANCY S GILSTON AU.D. CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 PARK AVE STE 1A
NEW YORK NY
10128-1211
US

IV. Provider business mailing address

1356 MADISON AVE APT 1 SOUTH
NEW YORK NY
10128-0826
US

V. Phone/Fax

Practice location:
  • Phone: 917-821-5014
  • Fax: 212-996-2703
Mailing address:
  • Phone: 917-821-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberH000020009
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: