Provider Demographics
NPI:1376541912
Name:GIL, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:GIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:J
Other - Last Name:GIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:575 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8886
Mailing Address - Country:US
Mailing Address - Phone:631-821-9000
Mailing Address - Fax:631-821-9114
Practice Address - Street 1:575 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8886
Practice Address - Country:US
Practice Address - Phone:631-821-9000
Practice Address - Fax:631-821-9114
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2015-01-22
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NY177114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
74F141Medicare ID - Type Unspecified
E89083Medicare UPIN