NPIMap

Individual provider Active NPI

Gabrielle Pezzulo, PA-C

  • Medical Physician Assistant
  • Limerick, PA
National Provider Identifier
1588064174
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
017869-1 Issued in NY
Practice address
33 W Ridge Pike Ste 627
Limerick, PA 19468-1824
Phone
(610) 226-6200
NPI assigned
Sep 2, 2014
Last updated
Apr 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA066269 PA
Medical Physician Assistant 363AM0700X 017869-1 NY Primary

Addresses

Primary practice location

33 W Ridge Pike Ste 627
Limerick, PA 19468-1824

Mailing address

PO Box 13579
Reading, PA 19612-3579
Phone (484) 628-1324

Other practice location 1

600 E 233rd St
Bronx, NY 10466-2604
Phone (718) 920-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY, PA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20200908000597 NJ Practitioner - Physician Assistant 2668776022 Reassigns benefits to 3 organizations
I20200924001495 NY Practitioner - Physician Assistant 2668776022 Reassigns benefits to 1 organization
I20250129003073 PA Practitioner - Physician Assistant 2668776022 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.15 of 100Reported as group
Quality
71.59
Promoting interoperability
100
Improvement activities
40
Cost
76.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
017869-1NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince May 26, 2020 Accepting new patients
Montefiore Medical Center CurrentSince May 26, 2020 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Aug 1, 2022 Accepting new patients
Shriners Hospitals for Children CurrentSince May 29, 2025 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Aug 1, 2022 Accepting new patients
Shriners Hospitals for Children Physician Assistant CurrentSince May 29, 2025 Accepting new patients
The Radiology Group of New Jersey, LLC Past Accepting new patients
A.G. Dikengil, MD, PA Past Accepting new patients
Shriners Hospitals for Children Past Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

1 Harmon Plz
Fl 10
Secaucus, NJ 07094
Phone (201) 636-7233

111 E 210th St
Bronx, NY 10467

600 E 233rd St
Bronx, NY 10466
Phone (718) 920-1640

3551 N Broad St
Philadelphia, PA 19140
Phone (215) 430-4000

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1588064174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13579",
            "city": "READING",
            "state": "PA",
            "postal_code": "196123579",
            "telephone_number": "484-628-1324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 W RIDGE PIKE STE 627",
            "city": "LIMERICK",
            "state": "PA",
            "postal_code": "194681824",
            "telephone_number": "610-226-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 E 233rd St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104662604",
            "country_code": "US",
            "telephone_number": "718-920-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEZZULO",
        "first_name": "GABRIELLE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-02",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA066269",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "017869-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Limerick, PA

Sources for this page

Verify at the official NPI Registry.