MEDICARE: GABRIELLE RABINOWITZ LLC

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	252Y00000X	Early Intervention Provider Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1457835670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GABRIELLE RABINOWITZ LLC

Provider Business Mailing Address
First Line	:	1360 OCEAN PKWY APT 5H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5626
Country	:	US
Telephone Number	:	917-304-1328
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5119
Country	:	US
Telephone Number	:	917-304-1328
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. GABRIELLE A RABINOWITZ
Credential	:	M.S.ED.
Telephone Number	:	917-304-1328

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	10/10/2018

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