Healthcare Provider Details

I. General information

NPI: 1821034265
Provider Name (Legal Business Name): JANINE GILLIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 OLD COUNTRY RD SUITE 100
PLAINVIEW NY
11803-4908
US

IV. Provider business mailing address

651 OLD COUNTRY RD SUITE 100
PLAINVIEW NY
11803-4908
US

V. Phone/Fax

Practice location:
  • Phone: 516-470-2150
  • Fax: 516-870-1477
Mailing address:
  • Phone: 516-470-2150
  • Fax: 516-870-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010705-1
License Number StateNY

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: