Healthcare Provider Details

I. General information

NPI: 1013691526
Provider Name (Legal Business Name): GABRIELLE ELIZABETH SANATANI MB BCH BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date: 01/18/2024
Reactivation Date: 08/06/2024

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5437
  • Fax:
Mailing address:
  • Phone: 212-305-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: