Provider Demographics
NPI:1508977521
Name:MEISEL, GAIL LUTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:LUTZ
Last Name:MEISEL
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 1:1170 5TH AVE
Mailing Address - Street 2:PH-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6527
Mailing Address - Country:US
Mailing Address - Phone:212-722-5800
Mailing Address - Fax:
Practice Address - Street 1:1170 5TH AVE
Practice Address - Street 2:PH-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6527
Practice Address - Country:US
Practice Address - Phone:212-722-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1099782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY150540328Medicaid
A65127Medicare UPIN