Provider Demographics
NPI:1124067988
Name:WOLFSBERGER, GABRIELLE J (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:J
Last Name:WOLFSBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4068 ALBANY POST RD
Mailing Address - Street 2:STE 4S
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-3900
Mailing Address - Country:US
Mailing Address - Phone:845-229-2123
Mailing Address - Fax:
Practice Address - Street 1:4068 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-3900
Practice Address - Country:US
Practice Address - Phone:845-229-2123
Practice Address - Fax:845-452-2156
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01160498Medicaid
NYA24802Medicare UPIN
NY01160498Medicaid