Provider Demographics
NPI:1366584195
Name:GABRIEL, CHANTAL D (MD)
Entity type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:D
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHANTAL
Other - Middle Name:D
Other - Last Name:SIMPSON-GABRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:226 STATE ST # 1018
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5502
Mailing Address - Country:US
Mailing Address - Phone:201-734-5853
Mailing Address - Fax:
Practice Address - Street 1:75 SUMMIT AVE STE 200
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8504
Practice Address - Country:US
Practice Address - Phone:201-734-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07511100208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0147516Medicaid
NJ0118682WJ8Medicare PIN