Provider Demographics
NPI:1215192430
Name:GORNAIL, JOANNE MARIE
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:GORNAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:SHABAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21939 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2518
Mailing Address - Country:US
Mailing Address - Phone:718-479-3774
Mailing Address - Fax:718-479-7066
Practice Address - Street 1:21939 89TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2518
Practice Address - Country:US
Practice Address - Phone:718-479-3774
Practice Address - Fax:718-479-7066
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist