Provider Demographics
NPI:1386888766
Name:GUSHWAY-HENRY, NEOLA (MD)
Entity type:Individual
Prefix:
First Name:NEOLA
Middle Name:
Last Name:GUSHWAY-HENRY
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 1:155 WILLOWBROOK BLVD STE110
Mailing Address - Street 2:PMB7579
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7033
Mailing Address - Country:US
Mailing Address - Phone:609-736-0090
Mailing Address - Fax:
Practice Address - Street 1:155 WILLOWBROOK BLVD STE110 PMB7579
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7033
Practice Address - Country:US
Practice Address - Phone:609-736-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09112000207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine