Healthcare Provider Details

I. General information

NPI: 1376541912
Provider Name (Legal Business Name): JOHN J GIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN J GIL M.D.

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

575 ROUTE 25A
ROCKY POINT NY
11778-8886
US

IV. Provider business mailing address

575 ROUTE 25A
ROCKY POINT NY
11778-8886
US

V. Phone/Fax

Practice location:
  • Phone: 631-821-9000
  • Fax: 631-821-9114
Mailing address:
  • Phone: 631-821-9000
  • Fax: 631-821-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number177114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: