Provider Demographics
NPI:1124706320
Name:THERETHA GILBERT, NP IN PSYCHIATRY PC
Entity type:Organization
Organization Name:THERETHA GILBERT, NP IN PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:THERETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-331-1760
Mailing Address - Street 1:31 E NANCY PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4322
Mailing Address - Country:US
Mailing Address - Phone:516-449-7807
Mailing Address - Fax:231-310-5299
Practice Address - Street 1:1398 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1612
Practice Address - Country:US
Practice Address - Phone:516-331-1760
Practice Address - Fax:231-310-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health