Individual
LAURA GILLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 ROOSEVELT AVE STE 300, SYOSSET, NY 11791-3064
(516) 758-4119
Mailing address
314 S OCEAN AVE APT 1B, FREEPORT, NY 11520-4957
(516) 448-6518
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11-3449823
—
NY
Enumeration date
12/29/2021
Last updated
12/29/2021
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