Provider Demographics
NPI:1396983755
Name:GAMEL, GERGIS ELNESR (PT)
Entity type:Individual
Prefix:
First Name:GERGIS
Middle Name:ELNESR
Last Name:GAMEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LUNDI CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6023
Mailing Address - Country:US
Mailing Address - Phone:917-337-0312
Mailing Address - Fax:718-983-5023
Practice Address - Street 1:180 LIVINGSTON ST
Practice Address - Street 2:SUITE 306
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5861
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:718-625-3931
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist