Gabriel Gustin MD PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

213265 Issued in NY

Legal business name

GABRIEL GUSTIN MD PC

Practice address

4036 82ND St Ste 2
Elmhurst, NY 11373-1312

Phone

(718) 478-0338

Fax

(718) 478-6050

NPI assigned

Jan 31, 2012

Organization subpart

No

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

Authorized official

Name

Gabriel Gustin, MDNPI 1780613562

Title

Owner

Phone

(917) 250-5893

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gabriel Gustin, M.D

  • Internal Medicine Physician
  • Jackson Heights, NY
  • NPI 1780613562
  Medicare reassignment NPD Authorized official
• Derly M Heredia, P.A.

  • Medical Physician Assistant
  • Elmhurst, NY
  • NPI 1316126287
  NPD (past)

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

{
    "created_epoch": "1327968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1902178486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "109560417",
            "telephone_number": "917-250-5893",
            "fax_number": "718-478-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4036 82ND ST STE 2",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731312",
            "telephone_number": "718-478-0338",
            "fax_number": "718-478-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GABRIEL GUSTIN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-31",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "GUSTIN",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-250-5893",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "213265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04463636",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Armando Fuentes, PHD
• Reiko Fujisawa, CAT
• Functional Physical Therapy Rehab PC
• Marlene Agnes Fussner, NP
• G Dental PC
• Elizabeth Gadsden, LCSW
• Martin J Gaffney, LCSW
• Gaga Pharmacy Inc
• Hanzle Gagaring
• Gains Physical Therapy P.C.

• Internal Medicine Physician in Elmhurst, NY
• Providers in Elmhurst, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.