Provider Demographics
NPI:1043294820
Name:VALLEY ADVANCED GAMMA KNIFE, LLC
Entity Type:Organization
Organization Name:VALLEY ADVANCED GAMMA KNIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-634-2222
Mailing Address - Street 1:PO BOX 12848
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-0848
Mailing Address - Country:US
Mailing Address - Phone:610-253-7444
Mailing Address - Fax:610-253-5771
Practice Address - Street 1:2407 BUTLER ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-5302
Practice Address - Country:US
Practice Address - Phone:610-253-7444
Practice Address - Fax:610-253-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical