Provider Demographics
NPI:1134292592
Name:GILLMAN, EUGENE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ROBERT
Last Name:GILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:46 14 197 STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-423-3888
Practice Address - Fax:718-229-6188
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY131079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
09A691OtherBC
0J136POtherHIP
0783497OtherAETNA
P435956OtherOXFORD
0783497OtherAETNA
P435956OtherOXFORD