Provider Demographics
NPI:1558503219
Name:GILL, GAGANDEEP (MD)
Entity Type:Individual
Prefix:MRS
First Name:GAGANDEEP
Middle Name:
Last Name:GILL
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 1:45 RESEARCH WAY SUITE 204
Mailing Address - Street 2:STONY BROOK ADMINISTRATIVE SERVICES LLC
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-615-8279
Mailing Address - Fax:
Practice Address - Street 1:205 N. BELLE MEADE RD.
Practice Address - Street 2:STONY BROOK INTERNAL MEDICINE
Practice Address - City:E. SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-444-4630
Practice Address - Fax:631-444-4617
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine