Provider Demographics
NPI:1265475339
Name:GIMBEL, JOSEPH BARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BARRY
Last Name:GIMBEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MILL ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4784
Mailing Address - Country:US
Mailing Address - Phone:781-641-0107
Mailing Address - Fax:781-641-1020
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE 307
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:781-641-0107
Practice Address - Fax:781-641-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1394213EP1101X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70536OtherBCBS - INDIVIDUAL
MAFALLONOther39212
MA0035708OtherNEIGHBORHOOD - INDIVIDUAL
MA0485872OtherCIGNA
MA0334863Medicaid
MA1196765OtherAETNA
MA33700OtherHPHC 1ST SENIORITY - IND.
MA706345OtherTUFTS - INDIVIDUAL
MA33700OtherHPHC 1ST SENIORITY - IND.
MA1196765OtherAETNA