Healthcare Provider Details

I. General information

NPI: 1932638616
Provider Name (Legal Business Name): DR. DIANNA GABALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK DR STE 3
WEST NYACK NY
10994-1966
US

IV. Provider business mailing address

1512 SPRUCE ST APT 1704
PHILADELPHIA PA
19102-4554
US

V. Phone/Fax

Practice location:
  • Phone: 845-268-0880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number307040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: