Provider Demographics
NPI:1508262643
Name:JALIL, GURBAN
Entity Type:Individual
Prefix:
First Name:GURBAN
Middle Name:
Last Name:JALIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 PARROTT PL APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3630
Mailing Address - Country:US
Mailing Address - Phone:646-894-3060
Mailing Address - Fax:
Practice Address - Street 1:92 PARROTT PL APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3630
Practice Address - Country:US
Practice Address - Phone:646-894-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst