Healthcare Provider Details

I. General information

NPI: 1386888766
Provider Name (Legal Business Name): NEOLA GUSHWAY-HENRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WILLOWBROOK BLVD STE110 PMB7579
WAYNE NJ
07470-7033
US

IV. Provider business mailing address

155 WILLOWBROOK BLVD STE110 PMB7579
WAYNE NJ
07470-7033
US

V. Phone/Fax

Practice location:
  • Phone: 609-736-0090
  • Fax:
Mailing address:
  • Phone: 609-736-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09112000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number25MA09112000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: