Provider Demographics
NPI:1811207541
Name:GABRIEL BERTRAND M.D. P.C.
Entity Type:Organization
Organization Name:GABRIEL BERTRAND M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-666-6084
Mailing Address - Street 1:37 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3127
Mailing Address - Country:US
Mailing Address - Phone:914-666-6084
Mailing Address - Fax:914-666-5817
Practice Address - Street 1:37 MOORE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3127
Practice Address - Country:US
Practice Address - Phone:914-666-6084
Practice Address - Fax:914-666-5817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114983207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12573Medicare PIN