=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518427467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SURJIT SINGH GILL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2019
-----------------------------------------------------
Last Update Date | 03/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 93 N FORDHAM RD
-----------------------------------------------------
City | HICKSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11801-6064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-957-9450
-----------------------------------------------------
Fax | 888-745-7138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 93 N FORDHAM RD
-----------------------------------------------------
City | HICKSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11801-6064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-957-9450
-----------------------------------------------------
Fax | 888-745-7138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------