MEDICARE: GABRIEL H BRANDEIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	58101	MA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	58101	MA
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	166195	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023093994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL H BRANDEIS M.D.

Provider Business Mailing Address
First Line	:	MEDICAL DEPARTMENT
Second Line	:	79-01 BROADWAY
City	:	NEW YORK
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:	718-334-3444
Fax Number	:	718-334-2879

Provider Business Practice Location Address
First Line	:	MEDICAL DEPARTMENT
Second Line	:	79-01 BROADWAY
City	:	NEW YORK
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:	718-334-3444
Fax Number	:	718-334-2879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/06/2020

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