MEDICARE: MR. BERNARD DELA CUESTA GABRIEL JR. RN

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	163W00000X	Registered Nurse	625271-1	NY

General Provider Information

NPI Number	:	1134491624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BERNARD DELA CUESTA GABRIEL JR. RN

Provider Business Mailing Address
First Line	:	312 36TH ST
Second Line	:	APT. 10
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4735
Country	:	US
Telephone Number	:	347-804-9230
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 36TH ST
Second Line	:	APT. 10
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4735
Country	:	US
Telephone Number	:	347-804-9230
Fax Number	:

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

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	01/31/2012

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