Provider Demographics
NPI:1578727194
Name:GABRIEL F. DEANGELIS MD PC
Entity Type:Organization
Organization Name:GABRIEL F. DEANGELIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-657-8171
Mailing Address - Street 1:16215 HIGHLAND AVE
Mailing Address - Street 2:1F
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3452
Mailing Address - Country:US
Mailing Address - Phone:718-657-8171
Mailing Address - Fax:718-657-0548
Practice Address - Street 1:16215 HIGHLAND AVE
Practice Address - Street 2:1F
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3452
Practice Address - Country:US
Practice Address - Phone:718-657-8171
Practice Address - Fax:718-657-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-13
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099931207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY475721OtherEMPIRE
NYOC3405OtherHEALTHNET
NY5424948002OtherCIGNA
NY47587Medicare PIN
NY475721OtherEMPIRE