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General NPI Number Information
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NPI Number | 1346227428
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Entity Type | Individual
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Provider Name | GLENN G GABISAN MD
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Gender | Male
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 776 SHREWSBURY AVE SUITE 201
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City | TINTON FALLS
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State | NJ
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Zip | 07724-3006
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Country | US
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Telephone | 732-530-4949
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Fax | 732-530-3618
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Provider Business Mailing Address
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Address Line | 776 SHREWSBURY AVE SUITE 201
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City | TINTON FALLS
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State | NJ
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Zip | 07724-3006
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Country | US
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Telephone | 732-530-4949
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Fax | 732-530-3618
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MA069963
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | 25MA06996300
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License Number State | NJ
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