MEDICARE: GABRIEL STUMP

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	225100000X	Physical Therapist	049152-01	NY

General Provider Information

NPI Number	:	1508586801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL STUMP

Provider Business Mailing Address
First Line	:	454 SAINT NICHOLAS AVE APT 2N
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7664
Country	:	US
Telephone Number	:	303-249-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	377 PARK AVE S FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-8807
Country	:	US
Telephone Number	:	862-337-0631
Fax Number	:

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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Directions to “ GABRIEL STUMP ” Practice Location

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