Basic Information
| Provider Information | |||||||||
| NPI: | 1013004654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GABRIELE | ||||||||
| FirstName: | FRED | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MS, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 MAIN RD | ||||||||
| Address2: | |||||||||
| City: | CORFU | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140369753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855996446 | ||||||||
| FaxNumber: | 5855993166 | ||||||||
| Practice Location | |||||||||
| Address1: | 860 MAIN RD. | ||||||||
| Address2: | |||||||||
| City: | CORFU | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140369753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855996446 | ||||||||
| FaxNumber: | 5855993166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F334997-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.