Provider Demographics
NPI:1063172013
Name:ETTIENNE, GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:ETTIENNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 ROCKAWAY PKWY APT D7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3112
Mailing Address - Country:US
Mailing Address - Phone:929-610-3571
Mailing Address - Fax:
Practice Address - Street 1:40 HEYWARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-7823
Practice Address - Country:US
Practice Address - Phone:718-858-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112603-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine