Provider Demographics
NPI:1356367569
Name:GABRIEL, JOSEPHINE ZETILIA
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ZETILIA
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 E 89TH ST
Mailing Address - Street 2:FL 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5123
Mailing Address - Country:US
Mailing Address - Phone:917-915-2866
Mailing Address - Fax:718-763-1203
Practice Address - Street 1:1477 E 89TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5123
Practice Address - Country:US
Practice Address - Phone:212-216-6601
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340463363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00252444OtherMEDICARE RAILROAD
NY02101751Medicaid
NY02101751Medicaid
P00252444OtherMEDICARE RAILROAD