Provider Demographics
NPI:1336192681
Name:GIBBONS, DON EUGENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:EUGENE
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BRIGANTINE RD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-1308
Mailing Address - Country:US
Mailing Address - Phone:609-494-0009
Mailing Address - Fax:609-660-2275
Practice Address - Street 1:703 MILL CREEK RD STE G1
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3828
Practice Address - Country:US
Practice Address - Phone:609-494-0009
Practice Address - Fax:609-660-2275
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100351300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ017151SW0Medicare ID - Type UnspecifiedRENDERING NUMBER