Provider Demographics
NPI:1124700679
Name:ESSILFIE, GABRIEL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:ESSILFIE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 ROLLING FORK WAY
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21738-9746
Mailing Address - Country:US
Mailing Address - Phone:609-668-4719
Mailing Address - Fax:
Practice Address - Street 1:2840 ROLLING FORK WAY
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MD
Practice Address - Zip Code:21738-9746
Practice Address - Country:US
Practice Address - Phone:609-668-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14857600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health