Healthcare Provider Details

I. General information

NPI: 1376620476
Provider Name (Legal Business Name): ISADORE P GUTWEIN MD & ROBERT A SABLE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3765 RIVERDALE AVE SUITE #7
BRONX NY
10463-1845
US

IV. Provider business mailing address

3765 RIVERDALE AVE SUITE #7
BRONX NY
10463-1845
US

V. Phone/Fax

Practice location:
  • Phone: 718-549-4267
  • Fax: 718-884-4885
Mailing address:
  • Phone: 718-549-4267
  • Fax: 718-884-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number121055
License Number StateNY

VIII. Authorized Official

Name: ISADORE P GUTWEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-549-4267