Provider Demographics
NPI:1053865428
Name:STILES, GAYLA MARIE ANGELES (LAC)
Entity Type:Individual
Prefix:
First Name:GAYLA MARIE
Middle Name:ANGELES
Last Name:STILES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CABRINI BLVD
Mailing Address - Street 2:#2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1106
Mailing Address - Country:US
Mailing Address - Phone:646-715-8799
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE
Practice Address - Street 2:#309
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6601
Practice Address - Country:US
Practice Address - Phone:646-715-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005810-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist