1194941591 NPI number — MRS. BONNIE RENEE GILLER MS, RD, CDN, CDE

Table of content: (NPI 1447754312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194941591 NPI number — MRS. BONNIE RENEE GILLER MS, RD, CDN, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLER
Provider First Name:
BONNIE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CDN, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194941591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
383 PLYMOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HEMPSTEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11552-2450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-486-4569
Provider Business Mailing Address Fax Number:
516-486-1792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
383 PLYMOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11552-2450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-486-4569
Provider Business Practice Location Address Fax Number:
516-486-1792
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  000251 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8000066 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1141750 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2142444 . This is a "VYTRA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8461009 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P797526 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100114175001 . This is a "UNITEDHEALTHCARE MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 205253P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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