Provider Demographics
NPI:1093722951
Name:COULEAS, GAYLE (ANP-C)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:
Last Name:COULEAS
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 MOTOR PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5175
Mailing Address - Country:US
Mailing Address - Phone:631-265-9355
Mailing Address - Fax:631-864-8504
Practice Address - Street 1:694 MOTOR PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5175
Practice Address - Country:US
Practice Address - Phone:631-265-9355
Practice Address - Fax:631-864-8504
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ68540Medicare UPIN
NY1648G1Medicare ID - Type UnspecifiedEMPIRE