=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346283256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELA LOPEZ ALLEN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1033 TABOR RD
-----------------------------------------------------
City | MORRIS PLAINS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07950-2860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-605-8900
-----------------------------------------------------
Fax | 973-605-8941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1033 TABOR RD
-----------------------------------------------------
City | MORRIS PLAINS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07950-2860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-605-8900
-----------------------------------------------------
Fax | 973-605-8941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MA05886600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------