Provider Demographics
NPI:1467697326
Name:SHALMI, GABRIEL Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:Y
Last Name:SHALMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 N MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-5152
Mailing Address - Country:US
Mailing Address - Phone:203-595-0809
Mailing Address - Fax:203-595-0866
Practice Address - Street 1:5678 RIVERDALE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2138
Practice Address - Country:US
Practice Address - Phone:718-601-0900
Practice Address - Fax:718-601-5560
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008427122300000X
NY046204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01649201Medicaid