MEDICARE: CHRISLANKA GABRIEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-479715	NJ

General Provider Information

NPI Number	:	1225991565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISLANKA GABRIEL

Provider Business Mailing Address
First Line	:	1800 STATE ROUTE 34 BLDG 3
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9168
Country	:	US
Telephone Number	:	732-749-8317
Fax Number	:	732-749-8318

Provider Business Practice Location Address
First Line	:	1800 STATE ROUTE 34 BLDG 3
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9168
Country	:	US
Telephone Number	:	732-749-8317
Fax Number	:	732-749-8318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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