Provider Demographics
NPI:1396288494
Name:GABRIELLI, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GABRIELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:DAVID
Other - Last Name:GABRIELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:967 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1620
Mailing Address - Country:US
Mailing Address - Phone:516-508-1554
Mailing Address - Fax:
Practice Address - Street 1:967 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1620
Practice Address - Country:US
Practice Address - Phone:516-508-1554
Practice Address - Fax:516-826-1461
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist