Provider Demographics
NPI:1386907319
Name:DORMAN, GISELE (MS ED)
Entity type:Individual
Prefix:
First Name:GISELE
Middle Name:
Last Name:DORMAN
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 1:150 PROSPECT PARK W
Mailing Address - Street 2:APT. 3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4566
Mailing Address - Country:US
Mailing Address - Phone:917-923-3213
Mailing Address - Fax:
Practice Address - Street 1:150 PROSPECT PARK W
Practice Address - Street 2:APT. 3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4566
Practice Address - Country:US
Practice Address - Phone:917-923-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist