Provider Demographics
NPI:1518244037
Name:GILBERT, NAN N (L AC)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:N
Last Name:GILBERT
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4757
Mailing Address - Country:US
Mailing Address - Phone:646-752-1668
Mailing Address - Fax:
Practice Address - Street 1:2326 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4757
Practice Address - Country:US
Practice Address - Phone:646-752-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001086171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001086OtherLICENSE NUMBER