Basic Information
Provider Information
NPI: 1467981043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILL
FirstName: NAVRAJ
MiddleName: SINGH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2811 TIETON DR
Address2:  
City: YAKIMA
State: WA
PostalCode: 989023761
CountryCode: US
TelephoneNumber: 5095758000
FaxNumber:  
Practice Location
Address1: 4422 3RD AVE
Address2:  
City: BRONX
State: NY
PostalCode: 104572545
CountryCode: US
TelephoneNumber: 7189609000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2017
LastUpdateDate: 07/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD61050634WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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