Provider Demographics
NPI:1669034856
Name:GABORO MEDICAL SUPPLY
Entity Type:Organization
Organization Name:GABORO MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLANNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-350-0446
Mailing Address - Street 1:140 N 2ND ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2528
Mailing Address - Country:US
Mailing Address - Phone:570-984-4700
Mailing Address - Fax:866-379-5580
Practice Address - Street 1:140 N 2ND ST UNIT 2
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2528
Practice Address - Country:US
Practice Address - Phone:570-984-4700
Practice Address - Fax:866-379-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies