Provider Demographics
NPI:1407567506
Name:ONEILL, GABRIELLE EIZABETH
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:EIZABETH
Last Name:ONEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14379 US ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-3103
Mailing Address - Country:US
Mailing Address - Phone:518-756-3124
Mailing Address - Fax:
Practice Address - Street 1:14379 US ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-3103
Practice Address - Country:US
Practice Address - Phone:518-756-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist