Provider Demographics
NPI:1225128101
Name:BERTRAND, GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:BERTRAND
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 1:37 MOORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3211
Mailing Address - Country:US
Mailing Address - Phone:914-666-6084
Mailing Address - Fax:914-666-5817
Practice Address - Street 1:37 MOORE AVENUE
Practice Address - Street 2:
Practice Address - City:MT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3211
Practice Address - Country:US
Practice Address - Phone:914-666-6084
Practice Address - Fax:914-666-5817
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114983207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00547053Medicaid
NY00547053Medicaid
B12573Medicare UPIN