Provider Demographics
NPI:1063684488
Name:GILL, JOEL ANDREW (LPN)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ANDREW
Last Name:GILL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 LURTING AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1443
Mailing Address - Country:US
Mailing Address - Phone:347-207-8028
Mailing Address - Fax:
Practice Address - Street 1:4136 BRUNER AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2028
Practice Address - Country:US
Practice Address - Phone:516-782-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY292286OtherLPN LICENCE NUMBER