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General NPI Number Information
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NPI Number | 1649415126
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Entity Type | Individual
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Provider Name | JEFFREY GISHKIN M.C.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 9445 S 50TH ST
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City | PHOENIX
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State | AZ
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Zip | 85044-5629
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Country | US
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Telephone | 602-708-4719
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Fax |
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Provider Business Mailing Address
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Address Line | 2747 S KIHEI RD APT A201
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City | KIHEI
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State | HI
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Zip | 96753-7235
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Country | US
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Telephone | 808-419-0446
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC0181
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC0079
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License Number State | AZ
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