Provider Demographics
NPI:1710580550
Name:GABISA MEDICAL MA PLLC
Entity Type:Organization
Organization Name:GABISA MEDICAL MA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-915-1305
Mailing Address - Street 1:106 W 131ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2031
Mailing Address - Country:US
Mailing Address - Phone:718-915-1305
Mailing Address - Fax:347-926-0988
Practice Address - Street 1:BOSTON LOGAN INTERNATIONAL AIRPORT
Practice Address - Street 2:TERMINAL E (AT DOOR E107)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128
Practice Address - Country:US
Practice Address - Phone:617-874-8059
Practice Address - Fax:347-926-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center