Healthcare Provider Details

I. General information

NPI: 1568254639
Provider Name (Legal Business Name): YEVHENIIA GABRIEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YEVHENIIA HUSLIEVA

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WASHINGTON AVE
IRVINGTON NJ
07111-3550
US

IV. Provider business mailing address

160 MORGAN ST APT 2108
JERSEY CITY NJ
07302-6272
US

V. Phone/Fax

Practice location:
  • Phone: 973-399-5000
  • Fax:
Mailing address:
  • Phone: 972-987-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03091800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: