=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326239112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GABRIELSEYEMDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2007
-----------------------------------------------------
Last Update Date | 12/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 WESTERN AVE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12203-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-482-4459
-----------------------------------------------------
Fax | 518-482-1465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 960 WESTERN AVE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12203-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-482-4459
-----------------------------------------------------
Fax | 518-482-1465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JOAN MARIE THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-482-4459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 096580-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------