Basic Information
| Provider Information | |||||||||
| NPI: | 1710580550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GABISA MEDICAL MA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 W 131ST ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100272031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189151305 | ||||||||
| FaxNumber: | 3479260988 | ||||||||
| Practice Location | |||||||||
| Address1: | BOSTON LOGAN INTERNATIONAL AIRPORT | ||||||||
| Address2: | TERMINAL E (AT DOOR E107) | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178748059 | ||||||||
| FaxNumber: | 3479260988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2020 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOSEPH | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | KEITH | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7189151305 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.