Healthcare Provider Details

I. General information

NPI: 1114145315
Provider Name (Legal Business Name): SANDRA GABRIEL T.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/19/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 72 W
MANAHAWKIN NJ
08050-2821
US

IV. Provider business mailing address

525 ROUTE 72 W
MANAHAWKIN NJ
08050-2821
US

V. Phone/Fax

Practice location:
  • Phone: 609-597-1903
  • Fax: 609-978-8343
Mailing address:
  • Phone: 609-597-1903
  • Fax: 609-978-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberTD2284
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number31TD00228400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: