Provider Demographics
NPI:1629062013
Name:CHOUCHANI, GABRIEL EMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:EMIL
Last Name:CHOUCHANI
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 1:30 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-633-6363
Mailing Address - Fax:716-633-6363
Practice Address - Street 1:30 N UNION RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5367
Practice Address - Country:US
Practice Address - Phone:716-633-6363
Practice Address - Fax:716-633-6363
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117387207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000506685009OtherBLUECROSSBLUESHIELD
NY00613507Medicaid
NY0708669OtherINDEPENDENT HEALTH
NYB71539Medicare ID - Type Unspecified