Provider Demographics
NPI:1366459281
Name:GIMBEL, BARRY R (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:R
Last Name:GIMBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2608
Mailing Address - Country:US
Mailing Address - Phone:516-746-2334
Mailing Address - Fax:516-746-2336
Practice Address - Street 1:215 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2608
Practice Address - Country:US
Practice Address - Phone:516-746-2334
Practice Address - Fax:516-746-2336
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400143048Medicare PIN
B17801Medicare UPIN