Provider Demographics
NPI:1972043610
Name:GAZZOLA, GABRIELLE LAREN MARIE (PA)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:LAREN MARIE
Last Name:GAZZOLA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL # 1118
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L. LEVY PLACE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-1653
Practice Address - Fax:212-289-6393
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2023-03-09
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Provider Licenses
StateLicense IDTaxonomies
NY020526-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant