1710307475 NPI number — MR. DANIEL GELARDI

Table of content: MR. DANIEL GELARDI (NPI 1710307475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710307475 NPI number — MR. DANIEL GELARDI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GELARDI
Provider First Name:
DANIEL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710307475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 HERITAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLISHTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-1550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-319-3003
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
923 HADDONFIELD RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08002-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-832-6727
Provider Business Practice Location Address Fax Number:
772-675-9100
Provider Enumeration Date:
04/21/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  876960 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 001212 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-15-20785 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)