Healthcare Provider Details

I. General information

NPI: 1417868639
Provider Name (Legal Business Name): GABRIELLE THAL-PRUZAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 FIFTH AVE
PELHAM NY
10803-1251
US

IV. Provider business mailing address

66 EUCLID AVE
HASTINGS ON HUDSON NY
10706-1110
US

V. Phone/Fax

Practice location:
  • Phone: 914-368-2995
  • Fax:
Mailing address:
  • Phone: 551-265-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: