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General NPI Number Information
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NPI Number | 1952437485
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Entity Type | Individual
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Provider Name | HOLLIE G. GAYNOR PA
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 PELHAM PKWY S BUILDING #4 ROOM 7N12
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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 | 718-918-6197
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Fax | 718-918-4074
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Provider Business Mailing Address
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Address Line | 2465 PALISADE AVE APT 3D
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City | BRONX
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State | NY
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Zip | 10463-6213
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Country | US
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Telephone | 718-601-8542
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 004647-1
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License Number State | NY
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