Provider Demographics
NPI:1689847667
Name:GIBSON, HARRIS ALAN (LICENSED CERTIFIED A)
Entity Type:Individual
Prefix:MR
First Name:HARRIS
Middle Name:ALAN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:LICENSED CERTIFIED A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 A WEST LINCOLN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-649-9896
Mailing Address - Fax:
Practice Address - Street 1:1001 A WEST LINCOLN DRIVE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-649-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00058900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist