Healthcare Provider Details

I. General information

NPI: 1912301052
Provider Name (Legal Business Name): GABRIEL GARDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BRIGHTON ST
BETHLEHEM PA
18015-1273
US

IV. Provider business mailing address

PO BOX 5520
BETHLEHEM PA
18015-0520
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-5810
  • Fax:
Mailing address:
  • Phone: 610-954-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105641
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: