MEDICARE: DOUGLAS GABRIELE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	161587	NY

General Provider Information

NPI Number	:	1689789216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS GABRIELE M.D.

Provider Business Mailing Address
First Line	:	28 WASHINGTON AVE
Second Line	:
City	:	WEST SAYVILLE
State	:	NY
Zip	:	11796-1605
Country	:	US
Telephone Number	:	631-589-6755
Fax Number	:

Provider Business Practice Location Address
First Line	:	82 MIDDLE COUNTRY RD
Second Line	:
City	:	CORAM
State	:	NY
Zip	:	11727-4411
Country	:	US
Telephone Number	:	631-854-2252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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