Healthcare Provider Details

I. General information

NPI: 1265475339
Provider Name (Legal Business Name): JOSEPH BARRY GIMBEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST SUITE 307
ARLINGTON MA
02476-4784
US

IV. Provider business mailing address

22 MILL ST SUITE 307
ARLINGTON MA
02476-4784
US

V. Phone/Fax

Practice location:
  • Phone: 781-641-0107
  • Fax: 781-641-1020
Mailing address:
  • Phone: 781-641-0107
  • Fax: 781-641-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1394
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number1394
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1394
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: