Healthcare Provider Details

I. General information

NPI: 1467398768
Provider Name (Legal Business Name): GABRIEL DE GEDEON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E 2ND ST
NEW YORK NY
10009-8001
US

IV. Provider business mailing address

693 5TH AVE APT 3
BROOKLYN NY
11215-6509
US

V. Phone/Fax

Practice location:
  • Phone: 212-777-4486
  • Fax:
Mailing address:
  • Phone: 917-741-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007676-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: