Provider Demographics
NPI:1568495786
Name:NEWSHAN, GAYLE THERESA I (PH D NP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:THERESA
Last Name:NEWSHAN
Suffix:I
Gender:F
Credentials:PH D NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LOH AVE
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4629
Mailing Address - Country:US
Mailing Address - Phone:914-964-7396
Mailing Address - Fax:914-366-0577
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:ST JOHNS RIVERSIDE PARK CARE CLINIC
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3402
Practice Address - Country:US
Practice Address - Phone:914-964-7396
Practice Address - Fax:914-964-7952
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335793 1163W00000X
NY300741363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01355706Medicaid
NY01355706Medicaid