Healthcare Provider Details

I. General information

NPI: 1114342730
Provider Name (Legal Business Name): GABRIEL MARTIN STRAUSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W IVY LANE
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

20 W IVY LANE
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-7766
  • Fax:
Mailing address:
  • Phone: 201-567-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI02660900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: