Provider Demographics
NPI:1588056758
Name:GABRIEL, GENEVIEVE KHONGHUN (MD,)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:KHONGHUN
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:CO
Other - Last Name:KHONGHUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 829642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9642
Mailing Address - Country:US
Mailing Address - Phone:866-470-6626
Mailing Address - Fax:413-599-0470
Practice Address - Street 1:89 FRENCH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1935
Practice Address - Country:US
Practice Address - Phone:732-235-7875
Practice Address - Fax:732-235-6620
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-106392084N0400X, 208000000X
NJ25MA108356002084N0400X, 2084N0402X, 208000000X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy