Provider Demographics
NPI:1659415404
Name:GILL, IQBAL SINGH (MD)
Entity Type:Individual
Prefix:
First Name:IQBAL
Middle Name:SINGH
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 1:1556 ISLIP AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717
Mailing Address - Country:US
Mailing Address - Phone:631-582-5325
Mailing Address - Fax:631-234-3635
Practice Address - Street 1:1556 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-582-5325
Practice Address - Fax:631-234-3635
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00620613Medicaid
37F721OtherMEDICARE ID
37F721OtherMEDICARE ID