Provider Demographics
NPI:1396301107
Name:FOSTER, GILLIAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 N MADA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2118
Mailing Address - Country:US
Mailing Address - Phone:917-204-6869
Mailing Address - Fax:
Practice Address - Street 1:44 JONES STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-878-9020
Practice Address - Fax:888-210-4701
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF02190755363LF0000X
NJ26NJ00918800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily