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General NPI Number Information
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NPI Number | 1598174195
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Entity Type | Organization
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Legal Business Name | ON-SITE MEDICAL DIAGNOSTICS P.C.
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 271 NORTH AVE SUITE # 316
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5104
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Country | US
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Telephone | 201-893-6663
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Fax |
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Provider Business Mailing Address
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Address Line | 40 MEMORIAL HWY #34F
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-8312
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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 | OWNER
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Name | DR. JACOB GEBRAEL
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Credential | M.D.
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Telephone | 201-893-6663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 260144
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License Number State | NY
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