Provider Demographics
NPI:1235132804
Name:GUNZBURG, ALLISON B (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:B
Last Name:GUNZBURG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1855
Mailing Address - Country:US
Mailing Address - Phone:973-763-2203
Mailing Address - Fax:763-762-9449
Practice Address - Street 1:71 2ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1855
Practice Address - Country:US
Practice Address - Phone:973-763-2203
Practice Address - Fax:763-762-9449
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08356900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0160229Medicaid
H85069Medicare UPIN