Basic Information
Provider Information | |||||||||
NPI: | 1033559117 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GIMBEL | ||||||||
FirstName: | PRIYANKA | ||||||||
MiddleName: | KALAPURAYIL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KALAPURAYIL | ||||||||
OtherFirstName: | PRIYANKA | ||||||||
OtherMiddleName: | S | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 125 W 25TH ST FL 7 | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100017247 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | KNOWLEDGE HEALTH | ||||||||
Address2: | 298 FIFTH AVE, FL 7 | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 10001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5162106767 | ||||||||
FaxNumber: | 6463500525 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2013 | ||||||||
LastUpdateDate: | 01/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036140310 | IL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 67773 | WI | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.