Provider Demographics
NPI:1992012785
Name:KAVANAGHT, GILAINE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:GILAINE
Middle Name:
Last Name:KAVANAGHT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FULTON AVENUE SUITE 502
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11553
Mailing Address - Country:US
Mailing Address - Phone:516-565-6322
Mailing Address - Fax:516-565-6522
Practice Address - Street 1:175 FULTON AVE STE 502
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3702
Practice Address - Country:US
Practice Address - Phone:516-565-6322
Practice Address - Fax:516-565-6522
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170652164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1750493706Medicaid