Healthcare Provider Details

I. General information

NPI: 1609866508
Provider Name (Legal Business Name): DANIEL GABRIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 GENESEE ST
AUBURN NY
13021-3503
US

IV. Provider business mailing address

144 GENESEE ST
AUBURN NY
13021-3503
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-8477
  • Fax: 315-515-3191
Mailing address:
  • Phone: 315-253-8477
  • Fax: 315-515-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number220117-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: