Provider Demographics
NPI:1669663050
Name:GILDSTON, PHYLLIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:GILDSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MIDDLE NECK RD
Mailing Address - Street 2:SUITE B-6
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1925
Mailing Address - Country:US
Mailing Address - Phone:516-482-4444
Mailing Address - Fax:
Practice Address - Street 1:275 MIDDLE NECK RD
Practice Address - Street 2:SUITE B-6
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1925
Practice Address - Country:US
Practice Address - Phone:516-482-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000296-1101YM0800X
NY000340-1106H00000X
NY000080-1231H00000X
NY000225-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist