Active NPI
George P Gazella Jr., M.A
- Psychologist
- Philadelphia, PA
National Provider Identifier
1740791029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS002708L
- Practice address
- 4040 Market St
Philadelphia, PA 19104-3003 - Phone
- (215) 895-5588
- NPI assigned
- Oct 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS002708L | PA | Primary |
Addresses
Primary practice location
4040 Market St
Philadelphia, PA 19104-3003
Mailing address
4040 Market St Ste 120
Philadelphia, PA 19104-3003
Phone (215) 895-5588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS002708L | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507852800000",
"number": "1740791029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4040 MARKET ST STE 120",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191043003",
"telephone_number": "215-895-5588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4040 MARKET ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191043003",
"telephone_number": "215-895-5588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAZELLA",
"first_name": "GEORGE",
"middle_name": "P",
"name_suffix": "Jr.",
"credential": "M.A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-13",
"last_updated": "2017-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS002708L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.