Provider Demographics
NPI:1114145315
Name:GABRIEL, SANDRA (TD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:TD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2821
Mailing Address - Country:US
Mailing Address - Phone:609-597-1903
Mailing Address - Fax:609-978-8343
Practice Address - Street 1:525 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2821
Practice Address - Country:US
Practice Address - Phone:609-597-1903
Practice Address - Fax:609-978-8343
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00228400156FX1800X
NJTD2284156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic