Provider Demographics
NPI:1467985309
Name:GASIMLI-GAMACHE, LEYLA (DO)
Entity Type:Individual
Prefix:
First Name:LEYLA
Middle Name:
Last Name:GASIMLI-GAMACHE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LEYLA
Other - Middle Name:
Other - Last Name:GASIMLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT. OF MEDICINE, HSC LEVEL 16, SUNY STONY BROOK HOSP
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-2058
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:DEPT. OF MEDICINE, HSC LEVEL 16, SUNY STONY BROOK HOSP
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2058
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program