Healthcare Provider Details

I. General information

NPI: 1144255696
Provider Name (Legal Business Name): RAPHAEL GABAY DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
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 Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAPHAEL GABAY
Title or Position: OFFICER
Credential: DO
Phone: 215-969-5650