Healthcare Provider Details

I. General information

NPI: 1356365845
Provider Name (Legal Business Name): MICHELLE GEBHARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

PO BOX 6010
HAUPPAUGE NY
11788-9010
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3000
  • Fax:
Mailing address:
  • Phone: 631-232-4000
  • Fax: 631-851-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number232115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: