Provider Demographics
NPI:1982219903
Name:GAVIGAN, JOY M (NP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:M
Last Name:GAVIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2527
Mailing Address - Country:US
Mailing Address - Phone:845-608-6551
Mailing Address - Fax:
Practice Address - Street 1:55 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3403
Practice Address - Country:US
Practice Address - Phone:914-787-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403114363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health