Provider Demographics
NPI:1023093994
Name:BRANDEIS, GABRIEL H (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:H
Last Name:BRANDEIS
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:MEDICAL DEPARTMENT
Mailing Address - Street 2:79-01 BROADWAY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-334-3444
Mailing Address - Fax:718-334-2879
Practice Address - Street 1:MEDICAL DEPARTMENT
Practice Address - Street 2:79-01 BROADWAY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-334-3444
Practice Address - Fax:718-334-2879
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58101207R00000X, 207RG0300X
NY166195207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110049558AMedicaid
NYBG3AMedicaid
MA110049558AMedicaid
MATX1811Medicare PIN