Healthcare Provider Details

I. General information

NPI: 1689895690
Provider Name (Legal Business Name): JAMIE GABEL PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST
NEW YORK NY
10021-3235
US

IV. Provider business mailing address

159 E 74TH ST
NEW YORK NY
10021-3235
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax:
Mailing address:
  • Phone: 212-737-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001268
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: