Provider Demographics
NPI:1285042267
Name:GABRIEL MEDICAL EQUIPMENT AND SUPPLY, INC
Entity Type:Organization
Organization Name:GABRIEL MEDICAL EQUIPMENT AND SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-686-4713
Mailing Address - Street 1:3260 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3260 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1526
Practice Address - Country:US
Practice Address - Phone:267-686-4713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000008526332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6000008526OtherCERTIFICATE OF REGISTRATION WITH PA DEPARTMENT OF HEALTH