Provider Demographics
NPI:1235128067
Name:DEANGELIS, GABRIEL FRANCIS (MD PC)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:FRANCIS
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16215 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3452
Mailing Address - Country:US
Mailing Address - Phone:718-657-8171
Mailing Address - Fax:718-657-0548
Practice Address - Street 1:16215 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3452
Practice Address - Country:US
Practice Address - Phone:718-657-8171
Practice Address - Fax:718-657-0548
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099931207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0C3405OtherHN
5424948002OtherCIGNA
475721OtherEMPIRE
E42011Medicare UPIN
5424948002OtherCIGNA