Healthcare Provider Details

I. General information

NPI: 1255499661
Provider Name (Legal Business Name): GERARD JOSEPH IGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 TENBROECK AVE
BRONX NY
10461-2007
US

IV. Provider business mailing address

565 W END AVE APARTMENT 18D
NEW YORK NY
10024-2705
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-9060
  • Fax: 718-828-9845
Mailing address:
  • Phone: 212-769-0467
  • Fax: 212-769-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number149545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: