Healthcare Provider Details

I. General information

NPI: 1821359829
Provider Name (Legal Business Name): GAYLE LORI TANCER M.S.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BENTLEY RD
PLAINVIEW NY
11803-2619
US

IV. Provider business mailing address

17 BENTLEY RD
PLAINVIEW NY
11803-2619
US

V. Phone/Fax

Practice location:
  • Phone: 516-513-0306
  • Fax:
Mailing address:
  • Phone: 516-513-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: