Provider Demographics
NPI:1538775630
Name:NEYHART, GINA LYNN
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LYNN
Last Name:NEYHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1512
Mailing Address - Country:US
Mailing Address - Phone:732-245-1697
Mailing Address - Fax:
Practice Address - Street 1:1041 NJ-36
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716
Practice Address - Country:US
Practice Address - Phone:732-788-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00947900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist