Healthcare Provider Details

I. General information

NPI: 1851465991
Provider Name (Legal Business Name): EDWARD C GABALSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 LAKEVILLE RD
NEW HYDE PARK NY
11042-1121
US

IV. Provider business mailing address

430 LAKEVILLE RD
NEW HYDE PARK NY
11042-1121
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7550
  • Fax: 718-413-1937
Mailing address:
  • Phone: 718-470-7550
  • Fax: 718-413-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number192424
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number192424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: