Basic Information
| Provider Information | |||||||||
| NPI: | 1902991946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRESSIN | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 585 MERRICK RD | ||||||||
| Address2: | C/O PREMIER CARE | ||||||||
| City: | LYNBROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115632311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167642273 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 585 MERRICK RD | ||||||||
| Address2: | C/O PREMIER CARE | ||||||||
| City: | LYNBROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115632311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167642273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 03/25/2014 | ||||||||
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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 | 207P00000X | 208292 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | O2089985 | 05 | NY | MEDICAID |