Provider Demographics
NPI:1598174195
Name:ON-SITE MEDICAL DIAGNOSTICS P.C.
Entity Type:Organization
Organization Name:ON-SITE MEDICAL DIAGNOSTICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-893-6663
Mailing Address - Street 1:40 MEMORIAL HWY
Mailing Address - Street 2:#34F
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-8312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:271 NORTH AVE
Practice Address - Street 2:SUITE # 316
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5104
Practice Address - Country:US
Practice Address - Phone:201-893-6663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260144261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service