Healthcare Provider Details

I. General information

NPI: 1063954576
Provider Name (Legal Business Name): LANGE GABRIEL BELLEVUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 FLUSHING AVE
BROOKLYN NY
11206-5026
US

IV. Provider business mailing address

13 BRADNER AVE
MIDDLETOWN NY
10940-3201
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-2666
  • Fax:
Mailing address:
  • Phone: 845-538-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number963226
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number325429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: