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General NPI Number Information
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NPI Number | 1588061311
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Entity Type | Individual
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Provider Name | JUNIOR OMAR GABRIEL D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 53 E 124TH ST
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City | NEW YORK
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State | NY
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Zip | 10035-1815
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Country | US
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Telephone | 212-410-8147
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Fax |
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Provider Business Mailing Address
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Address Line | 53 E 124TH ST
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City | NEW YORK
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State | NY
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Zip | 10035-1815
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 304145460
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 026171
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License Number State | NY
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