Healthcare Provider Details

I. General information

NPI: 1285547539
Provider Name (Legal Business Name): GLADYS ISRAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 MADISON ST
SYRACUSE NY
13210-2338
US

IV. Provider business mailing address

793 WILLOWBROOK COURT
MIDLAND ONTARIO
L4R4W9
CA

V. Phone/Fax

Practice location:
  • Phone: 315-426-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number905644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: