Provider Demographics
NPI:1447222625
Name:ABELES, GWEN D (MD)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:D
Last Name:ABELES
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-0002
Mailing Address - Country:US
Mailing Address - Phone:201-307-0075
Mailing Address - Fax:
Practice Address - Street 1:221 W GRAND AVE STE 102B
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1729
Practice Address - Country:US
Practice Address - Phone:201-307-0075
Practice Address - Fax:201-307-5072
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ066287207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1800172OtherUNITED HEALTHCARE
11466OtherHUDSON HEALTHPLANS
08U071OtherEMPIRE BLUECROSS BLUESHIELD
000000042299OtherGHI HMO
1C7736OtherHEALTHNET
8872440OtherCIGNA
2299921OtherGHI
103201OtherWELLCARE
P946339OtherOXFORD
NY02040655Medicaid
070013873OtherRAILROAD MEDICARE
5663484OtherAETNA
2299921OtherGHI
1C7736OtherHEALTHNET