Healthcare Provider Details

I. General information

NPI: 1184018475
Provider Name (Legal Business Name): GABRIELLI GOROSPE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PINE WEST PLZ SUITE 512
ALBANY NY
12205-5593
US

IV. Provider business mailing address

5 PINE WEST PLZ SUITE 512
ALBANY NY
12205-5593
US

V. Phone/Fax

Practice location:
  • Phone: 518-730-2014
  • Fax:
Mailing address:
  • Phone: 518-730-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number262450
License Number StateNY

VIII. Authorized Official

Name: GABRIELLI GOROSPE
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 518-956-2121