Provider Demographics
NPI:1790820744
Name:WILSON, GABRIELLE PAGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:PAGE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:PAGE-WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:630 W 168TH ST
Mailing Address - Street 2:PH 8 WEST, ROOM 864
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-3725
Mailing Address - Fax:212-305-6486
Practice Address - Street 1:ATRIA
Practice Address - Street 2:36 E 57TH STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-600-2000
Practice Address - Fax:212-540-0855
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224846207R00000X
NY249207207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine