MEDICARE: LEOR GABBAI P.A.

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	363AS0400X	Surgical Physician Assistant	008564	NY
2	363A00000X	Physician Assistant	008564	NY

General Provider Information

NPI Number	:	1528393766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEOR GABBAI P.A.

Provider Business Mailing Address
First Line	:	1231 E 68TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5721
Country	:	US
Telephone Number	:	718-916-4770
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 E 68TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5721
Country	:	US
Telephone Number	:	718-916-4770
Fax Number	:

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

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	05/19/2017

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