Provider Demographics
NPI:1205251584
Name:GARZON, GISELLE (ANP-G)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:GARZON
Suffix:
Gender:F
Credentials:ANP-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 JEREMY CIR
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2937
Mailing Address - Country:US
Mailing Address - Phone:631-513-7204
Mailing Address - Fax:
Practice Address - Street 1:180 E PULASKI RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1915
Practice Address - Country:US
Practice Address - Phone:631-425-2115
Practice Address - Fax:631-425-2213
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAG1113030363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400104199Medicare PIN