Provider Demographics
NPI:1942200472
Name:GASTELL, GILBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:
Last Name:GASTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4245
Mailing Address - Country:US
Mailing Address - Phone:201-833-7265
Mailing Address - Fax:201-227-6207
Practice Address - Street 1:408 37TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4804
Practice Address - Country:US
Practice Address - Phone:201-864-4477
Practice Address - Fax:201-864-9727
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04575900174400000X, 207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ398670OtherWELLCARE
NJ929783OtherAETNA HMO ID #
NJ1258206Medicaid
NJ13270OtherUNIVERSITY HEALTH PLANS
NJ54C141OtherEMPIRE BC/BS (UNION CITY)
NJP00256277OtherRR MDCR #
NJ239SU1OtherEMPIRE BC/BS (ENGLEWOOD)
NJ9611335OtherGHI ID #
NJ0111479000OtherAMERIHEALTH #
NJHP107OtherOXFORD ID #
NJ4092912OtherAETNA PPO ID #
NJ1258206Medicaid
NJ13270OtherUNIVERSITY HEALTH PLANS