Basic Information
| Provider Information | |||||||||
| NPI: | 1942200472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GASTELL | ||||||||
| FirstName: | GILBERTO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 TEANECK RD | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018337265 | ||||||||
| FaxNumber: | 2012276207 | ||||||||
| Practice Location | |||||||||
| Address1: | 408 37TH ST | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070874804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018644477 | ||||||||
| FaxNumber: | 2018649727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 05/26/2011 | ||||||||
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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 | 174400000X | 25MA04575900 | NJ | N | Other Service Providers | Specialist | 207R00000X | 25MA04575900 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 25MA04575900 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 398670 | 01 | NJ | WELLCARE | OTHER | 929783 | 01 | NJ | AETNA HMO ID # | OTHER | 1258206 | 05 | NJ | MEDICAID | 13270 | 01 | NJ | UNIVERSITY HEALTH PLANS | OTHER | 54C141 | 01 | NJ | EMPIRE BC/BS (UNION CITY) | OTHER | P00256277 | 01 | NJ | RR MDCR # | OTHER | 239SU1 | 01 | NJ | EMPIRE BC/BS (ENGLEWOOD) | OTHER | 9611335 | 01 | NJ | GHI ID # | OTHER | 0111479000 | 01 | NJ | AMERIHEALTH # | OTHER | HP107 | 01 | NJ | OXFORD ID # | OTHER | 4092912 | 01 | NJ | AETNA PPO ID # | OTHER |