Basic Information
| Provider Information | |||||||||
| NPI: | 1265475339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIMBEL | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | BARRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 MILL ST | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024764784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816410107 | ||||||||
| FaxNumber: | 7816411020 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 MILL ST | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024764784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816410107 | ||||||||
| FaxNumber: | 7816411020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 1394 | MA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ER0200X | 1394 | MA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology | 213ES0131X | 1394 | MA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | Y70536 | 01 | MA | BCBS - INDIVIDUAL | OTHER | FALLON | 01 | MA | 39212 | OTHER | 0035708 | 01 | MA | NEIGHBORHOOD - INDIVIDUAL | OTHER | 0485872 | 01 | MA | CIGNA | OTHER | 0334863 | 05 | MA | MEDICAID | 1196765 | 01 | MA | AETNA | OTHER | 33700 | 01 | MA | HPHC 1ST SENIORITY - IND. | OTHER | 706345 | 01 | MA | TUFTS - INDIVIDUAL | OTHER |