Provider Demographics
NPI:1467084335
Name:NAVEDO, GABRIEL ANTHONY
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANTHONY
Last Name:NAVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3313
Mailing Address - Country:US
Mailing Address - Phone:732-306-3628
Mailing Address - Fax:
Practice Address - Street 1:11 GORDON ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3313
Practice Address - Country:US
Practice Address - Phone:732-306-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN090827061109922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer