Provider Demographics
NPI:1073573101
Name:CORTES, GABRIEL (DO)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:CORTES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 MILLERSPORT HWY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2410
Mailing Address - Country:US
Mailing Address - Phone:716-836-1100
Mailing Address - Fax:
Practice Address - Street 1:760 MILLERSPORT HWY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2410
Practice Address - Country:US
Practice Address - Phone:716-836-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01585175Medicaid
9642521OtherGHI
NY00010036201OtherUNIVERA
NY211178200OtherDEPARTMENT OF LABOR
110144167OtherRAILROAD MEDICARE
NY000523125007OtherBLUE CROSS
NY0408027OtherINDEPENDENT HEALTH
9642521OtherGHI
NY01585175Medicaid