NPIMap

Individual provider Active NPI

Gabrielle D Jimenez, APN

  • Gerontology Nurse Practitioner
  • Mount Laurel, NJ
National Provider Identifier
1457812026
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
26NJ00907900 Issued in NJ
Practice address
4510 Church Rd
Mount Laurel, NJ 08054-2210
Phone
(856) 439-0060
Fax
(856) 452-0344
NPI assigned
Mar 27, 2019
Last updated
Aug 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 26NJ00907900 NJ Primary

Addresses

Primary practice location

4510 Church Rd
Mount Laurel, NJ 08054-2210

Mailing address

4510 Church Rd
Mount Laurel, NJ 08054-2210
Phone (856) 439-0060

Other identifiers 1

IdentifierTypeStateIssuer
14449580OtherNJCAQH

Other names 1

  • Gabrielle D Jimenez Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190418000099 NJ Practitioner - Nurse Practitioner 4880935923 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ennoble HC NJ PCGroup PAC ID 0345638185, 129 clinicians

Practice addresses (Care Compare)

2 University PLZ
Suite 204
Hackensack, NJ 07601-6211
Phone (973) 241-1356

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ennoble HC NJ III PC CurrentSince Sep 29, 2025 Accepting new patients
Ennoble HC NJ PC CurrentSince Jul 1, 2022 Accepting new patients
Ennoble HC NJ II PC CurrentSince Sep 29, 2025 Accepting new patients
Intellihealth, Inc. PastSince Apr 1, 2019 Accepting new patients

Locations

2 University Plz
Hackensack, NJ 07601
Phone (347) 778-0507

2 University Plz
Ste 204
Hackensack, NJ 07601
Phone (201) 564-0142

1000 Haddonfield Berlin Rd
Ste 205
Voorhees, NJ 08043
Phone (973) 241-1356

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1457812026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 CHURCH RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542210",
            "telephone_number": "856-439-0060",
            "fax_number": "856-452-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 CHURCH RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542210",
            "telephone_number": "856-439-0060",
            "fax_number": "856-452-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "GABRIELLE",
        "middle_name": "D",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ00907900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14449580",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GABRIELLE",
            "last_name": "JIMENEZ",
            "middle_name": "D",
            "credential": "APN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mount Laurel, NJ

Sources for this page

Verify at the official NPI Registry.