Provider Demographics
NPI:1851561328
Name:GAVRIEL, STANLEY (DPT)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:GAVRIEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6536 99TH ST
Mailing Address - Street 2:STE # 1D
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4358
Mailing Address - Country:US
Mailing Address - Phone:718-897-6869
Mailing Address - Fax:718-685-2101
Practice Address - Street 1:6536 99TH ST
Practice Address - Street 2:STE # 1D
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4358
Practice Address - Country:US
Practice Address - Phone:718-897-6869
Practice Address - Fax:718-685-2101
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0293841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300000094OtherMEDICARE (PTAN)