Provider Demographics
NPI:1821002254
Name:OLABISI, GAIL GRIFFIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:GRIFFIN
Last Name:OLABISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 PARKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-2847
Mailing Address - Country:US
Mailing Address - Phone:908-229-7507
Mailing Address - Fax:
Practice Address - Street 1:280 S HARRISON ST
Practice Address - Street 2:SUITE B-2
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1960
Practice Address - Country:US
Practice Address - Phone:973-677-7887
Practice Address - Fax:973-677-0946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA39430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11433OtherAETNA
NJ3672204Medicaid
NJ3672204Medicaid
NJC56743Medicare UPIN