Healthcare Provider Details

I. General information

NPI: 1700863743
Provider Name (Legal Business Name): RAPHAEL GABAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 ROOSEVELT BLVD
PHILADELPHIA PA
19115
US

IV. Provider business mailing address

9500 ROOSEVELT BLVD
PHILADELPHIA PA
19115
US

V. Phone/Fax

Practice location:
  • Phone: 215-969-5650
  • Fax: 215-969-5651
Mailing address:
  • Phone: 215-969-5650
  • Fax: 215-969-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberOS006494L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: