Provider Demographics
NPI:1871986513
Name:GAYAN, ALLA
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:GAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6411
Mailing Address - Country:US
Mailing Address - Phone:917-623-1913
Mailing Address - Fax:718-873-9311
Practice Address - Street 1:2036 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2819
Practice Address - Country:US
Practice Address - Phone:718-980-6100
Practice Address - Fax:718-873-9311
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600033-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse