Provider Demographics
NPI:1346283256
Name:ALLEN, GABRIELA LOPEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:LOPEZ
Last Name:ALLEN
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 1:1033 TABOR RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2860
Mailing Address - Country:US
Mailing Address - Phone:973-605-8900
Mailing Address - Fax:973-605-8941
Practice Address - Street 1:1033 TABOR RD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2860
Practice Address - Country:US
Practice Address - Phone:973-605-8900
Practice Address - Fax:973-605-8941
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05886600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6415202Medicaid
NJ752622058OtherTAX IDENTIFICATION