Provider Demographics
NPI:1609866508
Name:GABRIEL, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GABRIEL
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 1:144 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3503
Mailing Address - Country:US
Mailing Address - Phone:315-253-8477
Mailing Address - Fax:315-515-3191
Practice Address - Street 1:144 GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3503
Practice Address - Country:US
Practice Address - Phone:315-253-8477
Practice Address - Fax:315-515-3191
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220117-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2181331Medicaid
NYH46809Medicare UPIN
NYRA4834Medicare ID - Type UnspecifiedMEDICARE