Provider Demographics
NPI:1609449594
Name:MIZRAHI, GABRIELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:
Last Name:MIZRAHI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2198
Mailing Address - Country:US
Mailing Address - Phone:631-208-4460
Mailing Address - Fax:
Practice Address - Street 1:170 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2198
Practice Address - Country:US
Practice Address - Phone:631-208-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant