Provider Demographics
NPI:1669492229
Name:GILMAN, HOWARD ELIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ELIOT
Last Name:GILMAN
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:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-1227
Mailing Address - Country:US
Mailing Address - Phone:201-612-6050
Mailing Address - Fax:201-612-0422
Practice Address - Street 1:1172 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3936
Practice Address - Country:US
Practice Address - Phone:201-612-6050
Practice Address - Fax:201-612-0422
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA050949002084P0800X
NY1384792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0221503Medicaid
NJGI 631189Medicare ID - Type Unspecified
C05804Medicare UPIN