Provider Demographics
NPI:1497232847
Name:GABRA, AMIRA HAANY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:HAANY
Last Name:GABRA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 OAK ST APT 202
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1256
Mailing Address - Country:US
Mailing Address - Phone:917-402-1024
Mailing Address - Fax:
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:201-994-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00483400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant