Provider Demographics
NPI:1902203086
Name:GILL, LORI S (MS, ATC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:GILL
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BIRCHWOOD CT
Mailing Address - Street 2:APT 4K
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4529
Mailing Address - Country:US
Mailing Address - Phone:631-338-3306
Mailing Address - Fax:
Practice Address - Street 1:5250 FIELDSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2935
Practice Address - Country:US
Practice Address - Phone:718-519-2799
Practice Address - Fax:718-519-2735
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0017832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer