=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003301946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LATOYA NATALIE GAYLE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2018
-----------------------------------------------------
Last Update Date | 10/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 BECKS WOODS DR STE 102
-----------------------------------------------------
City | BEAR
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19701-3855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-355-2383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 ENGLE ST
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-894-3143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | C1-0025802
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------