Provider Demographics
NPI:1619115623
Name:GILL, RANDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDEEP
Middle Name:
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NEWPORT PKWY APT 3209
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1531
Mailing Address - Country:US
Mailing Address - Phone:151-051-7225
Mailing Address - Fax:
Practice Address - Street 1:40 NEWPORT PKWY APT 3209
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1531
Practice Address - Country:US
Practice Address - Phone:151-051-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111111207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine