Healthcare Provider Details

I. General information

NPI: 1538785423
Provider Name (Legal Business Name): GABRIEL NATHAN SKOLNICK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S OCTORARA TRL
PARKESBURG PA
19365-2100
US

IV. Provider business mailing address

2098 ROBERT FULTON HWY
PEACH BOTTOM PA
17563-9614
US

V. Phone/Fax

Practice location:
  • Phone: 610-857-6639
  • Fax:
Mailing address:
  • Phone: 717-823-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061577
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: