Provider Demographics
NPI:1003879875
Name:GAWEL, MAREK MARIAN (MD)
Entity Type:Individual
Prefix:
First Name:MAREK
Middle Name:MARIAN
Last Name:GAWEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-798-6700
Mailing Address - Fax:607-798-6745
Practice Address - Street 1:161 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 306
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-798-6700
Practice Address - Fax:607-798-6745
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI09360Medicare UPIN