1730914060 NPI number — GABBI HEALTH MEDICAL GROUP OF NEW JERSEY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730914060 NPI number — GABBI HEALTH MEDICAL GROUP OF NEW JERSEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GABBI HEALTH MEDICAL GROUP OF NEW JERSEY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730914060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10350 N VANCOUVER WAY # 1067
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97217-7530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-286-7235
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 MADISON AVE
Provider Second Line Business Practice Location Address:
5 AND 6 FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-286-7235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2024

Additional Information

Authorized Official

Authorized Official Last Name:
GRITZFELD
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS
Authorized Official Telephone Number:
503-482-8374

Provider Taxonomy Codes

  • Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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