Provider Demographics
NPI:1841233178
Name:GAMZEL NY, INC
Entity Type:Organization
Organization Name:GAMZEL NY, INC
Other - Org Name:REVIVAL HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SION
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-629-1000
Mailing Address - Street 1:5350 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-6703
Mailing Address - Country:US
Mailing Address - Phone:718-629-1000
Mailing Address - Fax:347-602-9061
Practice Address - Street 1:5350 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-6703
Practice Address - Country:US
Practice Address - Phone:718-629-1000
Practice Address - Fax:718-629-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001635251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01544449Medicaid
NY337299Medicare Oscar/Certification