Provider Demographics
NPI:1003633801
Name:JEAN-GILLES, EVA DIANNE
Entity type:Individual
Prefix:
First Name:EVA DIANNE
Middle Name:
Last Name:JEAN-GILLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVA DIANNE
Other - Middle Name:PASCUAL
Other - Last Name:CABANGON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18311 HILLSIDE AVE APT 9L
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4851
Mailing Address - Country:US
Mailing Address - Phone:917-319-2624
Mailing Address - Fax:
Practice Address - Street 1:4275 65TH PL
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5054
Practice Address - Country:US
Practice Address - Phone:718-540-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009354224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant