Healthcare Provider Details

I. General information

NPI: 1588272033
Provider Name (Legal Business Name): GABRIEL JEU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 KENNY RD #1045
COLUMBUS OH
43220-4034
US

IV. Provider business mailing address

4505 KENNY RD # 1045
COLUMBUS OH
43220-4034
US

V. Phone/Fax

Practice location:
  • Phone: 216-282-4364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2020014575
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: