Basic Information
Provider Information
NPI: 1619150331
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REDELMAN-SIDI
FirstName: GIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 633 3RD AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100176706
CountryCode: US
TelephoneNumber: 2126392000
FaxNumber:  
Practice Location
Address1: 1275 YORK AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100656007
CountryCode: US
TelephoneNumber: 2126398475
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/17/2007
LastUpdateDate: 04/07/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X268744NYY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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