Provider Demographics
NPI:1558463802
Name:GABRIELS, FIRMIN (F) FORREST (MD)
Entity Type:Individual
Prefix:DR
First Name:FIRMIN (F)
Middle Name:FORREST
Last Name:GABRIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-482-4459
Mailing Address - Fax:518-482-1465
Practice Address - Street 1:960 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-482-4459
Practice Address - Fax:518-482-1465
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096580-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00406444001OtherBLUE SHIELD
NY80-13963OtherEMPIRE
NY17178OtherMVP
NY50965OtherGHI
NY00542998Medicaid
NY10007200OtherGDPHP
NY51376OtherBLUE CROSS
NYB80849Medicare UPIN
NY10007200OtherGDPHP