Provider Demographics
NPI:1952777187
Name:GILL FORENSIC SERVICES, LLC
Entity Type:Organization
Organization Name:GILL FORENSIC SERVICES, LLC
Other - Org Name:DR. SHELLY GILL
Other - Org Type:Other Name
Authorized Official - Title/Position:FORENSIC DEATH AND PSYCH EXAMINER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:NYCOLE
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-521-8321
Mailing Address - Street 1:3209 OVERLOOK CIR
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-1288
Mailing Address - Country:US
Mailing Address - Phone:845-680-6746
Mailing Address - Fax:845-680-6746
Practice Address - Street 1:125 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5529
Practice Address - Country:US
Practice Address - Phone:646-477-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101Y00000X
171M00000X, 171W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty