Basic Information
| Provider Information | |||||||||
| NPI: | 1023093994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDEIS | ||||||||
| FirstName: | GABRIEL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDICAL DEPARTMENT | ||||||||
| Address2: | 79-01 BROADWAY | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183343444 | ||||||||
| FaxNumber: | 7183342879 | ||||||||
| Practice Location | |||||||||
| Address1: | MEDICAL DEPARTMENT | ||||||||
| Address2: | 79-01 BROADWAY | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183343444 | ||||||||
| FaxNumber: | 7183342879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 58101 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 58101 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | 166195 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110049558A | 05 | MA | MEDICAID | BG3A | 05 | NY | MEDICAID |