Provider Demographics
NPI:1083906564
Name:HENRIQUEZ, GABRIELA MARIA (MD)
Entity Type:Individual
Prefix:MS
First Name:GABRIELA
Middle Name:MARIA
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 73RD ST APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3122
Mailing Address - Country:US
Mailing Address - Phone:202-744-3623
Mailing Address - Fax:
Practice Address - Street 1:2452 BRONX PARK E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7503
Practice Address - Country:US
Practice Address - Phone:718-881-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine