Provider Demographics
NPI:1811508278
Name:GILMAN, GEOFFREY JAMES
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:JAMES
Last Name:GILMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-1085
Mailing Address - Country:US
Mailing Address - Phone:845-514-3535
Mailing Address - Fax:
Practice Address - Street 1:47 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1085
Practice Address - Country:US
Practice Address - Phone:845-514-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2022-09-15
Deactivation Date:2020-08-12
Deactivation Code:
Reactivation Date:2022-09-15
Provider Licenses
StateLicense IDTaxonomies
NY006689171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist