Healthcare Provider Details

I. General information

NPI: 1366584195
Provider Name (Legal Business Name): CHANTAL D GABRIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHANTAL D SIMPSON-GABRIEL MD

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/06/2024
Certification Date: 04/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SUMMIT AVE STE 200
HACKENSACK NJ
07601-8504
US

IV. Provider business mailing address

226 STATE ST # 1018
HACKENSACK NJ
07601-5502
US

V. Phone/Fax

Practice location:
  • Phone: 201-734-5853
  • Fax:
Mailing address:
  • Phone: 201-734-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA07511100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA07511100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0147516
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: