Provider Demographics
NPI:1275702300
Name:GILL, JASMEET (MD)
Entity Type:Individual
Prefix:
First Name:JASMEET
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 BROCKTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9273
Mailing Address - Country:US
Mailing Address - Phone:716-795-0077
Mailing Address - Fax:716-795-0088
Practice Address - Street 1:6000 BROCKTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9273
Practice Address - Country:US
Practice Address - Phone:716-795-0077
Practice Address - Fax:716-795-0088
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258136207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400267932Medicare PIN