Provider Demographics
NPI:1962662031
Name:GOROSPE-HUBER, GABRIELLI ENCARNACION (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLI
Middle Name:ENCARNACION
Last Name:GOROSPE-HUBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PINE WEST PLZ
Mailing Address - Street 2:SUITE 512
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5593
Mailing Address - Country:US
Mailing Address - Phone:518-956-2121
Mailing Address - Fax:
Practice Address - Street 1:5 PINE WEST PLZ
Practice Address - Street 2:SUITE 512
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5593
Practice Address - Country:US
Practice Address - Phone:518-956-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2624502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY62712OtherALBANY MEDICAL CENTER