Provider Demographics
NPI:1548599533
Name:GILL, GURPREET (MD)
Entity type:Individual
Prefix:
First Name:GURPREET
Middle Name:
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:676 COUNTY ROAD 39A
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5241
Mailing Address - Country:US
Mailing Address - Phone:934-213-4970
Mailing Address - Fax:934-213-4071
Practice Address - Street 1:676 COUNTY ROAD 39A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5241
Practice Address - Country:US
Practice Address - Phone:934-213-4970
Practice Address - Fax:934-213-4971
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2761972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03917388Medicaid
NY03917388Medicaid