Provider Demographics
NPI:1104063064
Name:BARON GABRIEL, ICYNTH M (MD)
Entity type:Individual
Prefix:
First Name:ICYNTH
Middle Name:M
Last Name:BARON GABRIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ICYNTH
Other - Middle Name:BARON
Other - Last Name:GABRIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1318 VINCENZO DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2768
Mailing Address - Country:US
Mailing Address - Phone:732-341-7815
Mailing Address - Fax:
Practice Address - Street 1:1318 VINCENZO DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2768
Practice Address - Country:US
Practice Address - Phone:732-341-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06275100207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH67968Medicare UPIN