Provider Demographics
NPI:1336422716
Name:GARY A, HEUBEL, O.D.,P.A.
Entity type:Organization
Organization Name:GARY A, HEUBEL, O.D.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HEUBEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-202-0911
Mailing Address - Street 1:34 LANES MILL RD
Mailing Address - Street 2:DORADO PLAZA
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7056
Mailing Address - Country:US
Mailing Address - Phone:732-202-0911
Mailing Address - Fax:732-202-0920
Practice Address - Street 1:34 LANES MILL RD
Practice Address - Street 2:DORADO PLAZA
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7056
Practice Address - Country:US
Practice Address - Phone:732-202-0911
Practice Address - Fax:732-202-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00397500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ602125OtherPTAN
NJ1867300Medicaid
NJ230940Medicare PIN
NJ602125OtherPTAN