Basic Information
| Provider Information | |||||||||
| NPI: | 1467985309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GASIMLI-GAMACHE | ||||||||
| FirstName: | LEYLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| OtherLastName: | GASIMLI | ||||||||
| OtherFirstName: | LEYLA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | DEPT. OF MEDICINE, HSC LEVEL 16, SUNY STONY BROOK HOSP | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314442058 | ||||||||
| FaxNumber: | 6314442493 | ||||||||
| Practice Location | |||||||||
| Address1: | DEPT. OF MEDICINE, HSC LEVEL 16, SUNY STONY BROOK HOSP | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314442058 | ||||||||
| FaxNumber: | 6314442493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.