Provider Demographics
NPI:1780736223
Name:GILLE, ISABELLE M (PHD)
Entity type:Individual
Prefix:DR
First Name:ISABELLE
Middle Name:M
Last Name:GILLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MERRICK AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3434
Mailing Address - Country:US
Mailing Address - Phone:516-379-5197
Mailing Address - Fax:
Practice Address - Street 1:124 MERRICK AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3434
Practice Address - Country:US
Practice Address - Phone:516-379-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008575-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPSYS08575-3OtherPSYCHOLOGIST
NYV50771Medicare ID - Type UnspecifiedPSYCHOLOGIST