Provider Demographics
NPI:1043434970
Name:GABRIELLE, ROBERT KENNETH JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:GABRIELLE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 KINGS HWY
Mailing Address - Street 2:PO BOX 378
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1439
Mailing Address - Country:US
Mailing Address - Phone:845-268-3332
Mailing Address - Fax:845-268-3580
Practice Address - Street 1:472 KINGS HWY
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1439
Practice Address - Country:US
Practice Address - Phone:845-268-3332
Practice Address - Fax:845-268-3580
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02496528Medicaid