Provider Demographics
NPI:1114651114
Name:HUDLEY, GABRIELLE DORA
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:DORA
Last Name:HUDLEY
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 1:2933 VAUXHALL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-1248
Mailing Address - Country:US
Mailing Address - Phone:187-784-8089
Mailing Address - Fax:908-573-2286
Practice Address - Street 1:216 OSBORNE TER
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2104
Practice Address - Country:US
Practice Address - Phone:973-573-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy