Healthcare Provider Details

I. General information

NPI: 1619390879
Provider Name (Legal Business Name): GPM PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7715 4TH AVE
BROOKLYN NY
11209-3439
US

IV. Provider business mailing address

7715 4TH AVE
BROOKLYN NY
11209-3439
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-2300
  • Fax: 718-836-2305
Mailing address:
  • Phone: 718-833-2300
  • Fax: 718-836-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ELIAS GABRIEL
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 718-833-2300