Provider Demographics
NPI:1902832934
Name:GUBMAN, DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GUBMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SHEPPARD RD
Mailing Address - Street 2:STE 303
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4787
Mailing Address - Country:US
Mailing Address - Phone:856-751-0220
Mailing Address - Fax:856-751-0222
Practice Address - Street 1:2 SHEPPARD RD
Practice Address - Street 2:STE 303
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4787
Practice Address - Country:US
Practice Address - Phone:856-751-0220
Practice Address - Fax:856-751-0222
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA0005166152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
501029OtherAETNA
NJ5300100Medicaid
550480004OtherCIGNA
NJ170369OtherHORIZON BC/BS
0759379000OtherAMERIHEALTH
NJ5300100Medicaid
501029OtherAETNA
NJGU170369Medicare ID - Type Unspecified
1003320001Medicare NSC