Provider Demographics
NPI:1003206376
Name:GEBRAIEL, PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:GEBRAIEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MAPLE STREAM RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2459
Mailing Address - Country:US
Mailing Address - Phone:609-448-6740
Mailing Address - Fax:
Practice Address - Street 1:113 MAPLE STREAM RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2459
Practice Address - Country:US
Practice Address - Phone:609-448-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70012629111N00000X
NJ38MC00764400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ92-1570085Medicaid