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General NPI Number Information
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NPI Number | 1427584580
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Entity Type | Individual
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Provider Name | CHANTAL SAN MIGUEL GICQUEL M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 1400 PELHAM PKWY S
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City | BRONX
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State | NY
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Zip | 10461-1138
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Country | US
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Telephone | 718-918-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 2 MARDON RD
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City | LARCHMONT
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State | NY
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Zip | 10538-1754
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Country | US
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Telephone | 312-810-0656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 305026-01
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License Number State | NY
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