=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255192522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELLE JULIA PINTER CIMENT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2024
-----------------------------------------------------
Last Update Date | 01/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14004 JEWEL AVE
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-1654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-512-2410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74 MARGARET AVE
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11559-1826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-512-2410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 1220002
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------