Provider Demographics
NPI:1699754804
Name:GUARDARRAMAS, GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:GUARDARRAMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 111TH ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1813
Mailing Address - Country:US
Mailing Address - Phone:212-222-1142
Mailing Address - Fax:212-222-0220
Practice Address - Street 1:600 W 111TH ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1813
Practice Address - Country:US
Practice Address - Phone:212-222-1142
Practice Address - Fax:212-222-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004616160Medicaid
NYA60911Medicare UPIN
NY17A161Medicare PIN