Provider Demographics
NPI:1174947410
Name:ALLATTA, GILLIAN IRENE (CPM, LM)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:IRENE
Last Name:ALLATTA
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:ALLATTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:61 MARBLE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6734
Mailing Address - Country:US
Mailing Address - Phone:505-231-1185
Mailing Address - Fax:
Practice Address - Street 1:61 MARBLE HILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6734
Practice Address - Country:US
Practice Address - Phone:505-231-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MW00001600176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife