Provider Demographics
NPI:1750686580
Name:GABRIEL, EMAD MALAK (DPM)
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:MALAK
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 AVENUE C STE 201
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3899
Mailing Address - Country:US
Mailing Address - Phone:201-535-8978
Mailing Address - Fax:
Practice Address - Street 1:654 AVENUE C STE 201
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3899
Practice Address - Country:US
Practice Address - Phone:201-535-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
211D00000X
NYN006569213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric