Provider Demographics
NPI:1598855231
Name:IMMANUEL, GAMALIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GAMALIEL
Middle Name:
Last Name:IMMANUEL
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 1:230 HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-8115
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:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:516-565-5556
Practice Address - Fax:516-483-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142841207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17485Medicare UPIN