Basic Information
| Provider Information | |||||||||
| NPI: | 1265429179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LURVEY | ||||||||
| FirstName: | GABRIEL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 LANSING STREET | ||||||||
| Address2: | AMMS, PC | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155670455 | ||||||||
| FaxNumber: | 3152531795 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 NELSON ST STE 320 | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155670780 | ||||||||
| FaxNumber: | 3157028393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 11/29/2017 | ||||||||
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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 | 207Q00000X | 14516 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 14516 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 276638 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04155139 | 05 | NY | MEDICAID |