Provider Demographics
NPI:1790013225
Name:GIL, JESSICA IV
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:GIL
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 34TH AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3051
Mailing Address - Country:US
Mailing Address - Phone:347-678-2071
Mailing Address - Fax:
Practice Address - Street 1:8216 34TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3051
Practice Address - Country:US
Practice Address - Phone:347-678-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23386101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)