Provider Demographics
NPI:1114375706
Name:GABALLAH, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GABALLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EAGLE ROCK AVE
Mailing Address - Street 2:STE 154
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3168
Mailing Address - Country:US
Mailing Address - Phone:201-447-4772
Mailing Address - Fax:862-701-6444
Practice Address - Street 1:120 EAGLE ROCK AVE
Practice Address - Street 2:STE 154
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3168
Practice Address - Country:US
Practice Address - Phone:201-447-4772
Practice Address - Fax:862-701-6444
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10753500208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program