Provider Demographics
NPI:1366461436
Name:DASSA, GABRIEL L (DO)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:L
Last Name:DASSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4755
Mailing Address - Country:US
Mailing Address - Phone:914-242-8721
Mailing Address - Fax:
Practice Address - Street 1:2772 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4029
Practice Address - Country:US
Practice Address - Phone:718-993-3536
Practice Address - Fax:718-993-3464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190113207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01883274Medicaid
NY02100810Medicaid
NY01883274Medicaid
NY01883274Medicaid