Provider Demographics
NPI:1538469713
Name:GAMALIEL IMMANUEL,PHYSICIAN PC
Entity Type:Organization
Organization Name:GAMALIEL IMMANUEL,PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN P.C.
Authorized Official - Prefix:
Authorized Official - First Name:GAMALIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IMMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-565-5556
Mailing Address - Street 1:230 HILTON AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550
Mailing Address - Country:US
Mailing Address - Phone:516-565-5556
Mailing Address - Fax:516-483-0396
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-565-5556
Practice Address - Fax:516-483-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142841207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
65A041Medicare PIN
B17485Medicare UPIN