Provider Demographics
NPI:1154375152
Name:LEMLICH, GABRIELLE P (MD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:P
Last Name:LEMLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20420
Mailing Address - Street 2:PARK WEST STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1513
Mailing Address - Country:US
Mailing Address - Phone:917-787-2112
Mailing Address - Fax:
Practice Address - Street 1:411 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2421
Practice Address - Country:US
Practice Address - Phone:718-383-2515
Practice Address - Fax:718-383-6717
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2013-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY163851207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE99921Medicare UPIN