Provider Demographics
NPI:1386907269
Name:GAVURIN, GILLIAN STAR (MS ED)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:STAR
Last Name:GAVURIN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 1ST AVE
Mailing Address - Street 2:4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:272 1ST AVE
Practice Address - Street 2:4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-1801
Practice Address - Country:US
Practice Address - Phone:917-757-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist