Healthcare Provider Details

I. General information

NPI: 1033343322
Provider Name (Legal Business Name): SUZANNE GABRIELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 AIRPORT RD
LAKEWOOD NJ
08701-6927
US

IV. Provider business mailing address

160 AIRPORT RD P.O. BOX 238
LAKEWOOD NJ
08701-6927
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-1888
  • Fax:
Mailing address:
  • Phone: 732-367-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC010310
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: