Provider Demographics
NPI:1376620476
Name:ISADORE P GUTWEIN MD & ROBERT A SABLE MD PC
Entity Type:Organization
Organization Name:ISADORE P GUTWEIN MD & ROBERT A SABLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISADORE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUTWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-549-4267
Mailing Address - Street 1:3765 RIVERDALE AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1845
Mailing Address - Country:US
Mailing Address - Phone:718-549-4267
Mailing Address - Fax:718-884-4885
Practice Address - Street 1:3765 RIVERDALE AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1845
Practice Address - Country:US
Practice Address - Phone:718-549-4267
Practice Address - Fax:718-884-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121055207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33D0136726OtherCLIA
NY00631576Medicaid
NY33D0136726OtherCLIA