Provider Demographics
NPI:1205834140
Name:LEVI, GABRIEL S (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:S
Last Name:LEVI
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 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:770-666-9097
Practice Address - Street 1:1 DIAMOND HILL RD FL G
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8699
Practice Address - Fax:908-673-7388
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188765207ZP0102X
NJ25MA10812200207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400062328OtherNGS
NY01629372Medicaid
NYG09206Medicare UPIN
NYA400062328OtherNGS
NY2510770211Medicare PIN