| Gabriel Gustin Md Pc | |
|
4036 82nd St Ste 2 Elmhurst NY 11373-1312 | |
| (718) 478-0338 | |
| (718) 478-6050 |
| Full Name | Gabriel Gustin Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4036 82nd St Ste 2, Elmhurst, New York |
| Authorized Official Name and Position | Gabriel Gustin (OWNER) |
| Authorized Official Contact | 9172505893 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gabriel Gustin Md Pc Po Box 417 New City NY 10956-0417 Ph: (917) 250-5893 | Gabriel Gustin Md Pc 4036 82nd St Ste 2 Elmhurst NY 11373-1312 Ph: (718) 478-0338 |
| NPI Number | 1902178486 |
|---|---|
| Provider Enumeration Date | 01/31/2012 |
| Last Update Date | 11/07/2016 |
| Medicare PECOS PAC ID | 7012808512 |
|---|---|
| Medicare Enrollment ID | O20120224000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902178486 | NPI | - | NPPES |
| 04463636 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 213265 (New York) | Primary |
| Provider Name | Gabriel Gustin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780613562 PECOS PAC ID: 7719887694 Enrollment ID: I20040109000143 |
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