Provider Demographics
NPI:1720045750
Name:GLEASON, ABIGAIL (MD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:GLEASON
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 1:172 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4911
Mailing Address - Country:US
Mailing Address - Phone:732-254-1500
Mailing Address - Fax:732-254-1436
Practice Address - Street 1:172 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4911
Practice Address - Country:US
Practice Address - Phone:732-254-1500
Practice Address - Fax:732-254-1436
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07158200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G52193Medicare UPIN