MEDICARE: ANGELIC GAYLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	287864-1	NY
2	163W00000X	Registered Nurse	633761-1	NY

General Provider Information

NPI Number	:	1841460417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIC GAYLE

Provider Business Mailing Address
First Line	:	2706 HARDING AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 HARDING AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3130
Country	:	US
Telephone Number	:	718-219-4946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	09/21/2010

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Directions to “ ANGELIC GAYLE ” Practice Location

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