Provider Demographics
NPI:1346378379
Name:GILL, DEVENDRA KAUR (MD)
Entity Type:Individual
Prefix:
First Name:DEVENDRA
Middle Name:KAUR
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEVENDRA
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1556 ISLIP AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717
Mailing Address - Country:US
Mailing Address - Phone:631-582-5325
Mailing Address - Fax:631-234-3635
Practice Address - Street 1:1556 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-582-5325
Practice Address - Fax:631-234-3635
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00620604Medicaid
NY37F71Medicare ID - Type Unspecified
NYD02191Medicare UPIN