Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 70012629 | NY |
NPI | 1003206376 |
---|---|
Provider Name | Dr. Peter Gebraiel |
First Address | Staten Island, NY 10306 |
Second Address | Staten Island, NY 10306-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2015 |
Last Update Date | 26/01/2015 |