Provider Demographics
NPI:1902011455
Name:GABRIEL, ANGELA NIKOLAEVNA (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:NIKOLAEVNA
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 WALDO AVE
Mailing Address - Street 2:APT 1-H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2247
Mailing Address - Country:US
Mailing Address - Phone:646-546-9910
Mailing Address - Fax:
Practice Address - Street 1:900 BROADWAY
Practice Address - Street 2:SUIT 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1210
Practice Address - Country:US
Practice Address - Phone:646-546-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003053-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist