=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891764924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW GILBERT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2006
-----------------------------------------------------
Last Update Date | 06/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 W 72ND ST 3RD FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-799-7777
-----------------------------------------------------
Fax | 212-799-7772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 W 72ND ST 3RD FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-799-7777
-----------------------------------------------------
Fax | 212-799-7772
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 253348
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 253348
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------