Healthcare Provider Details

I. General information

NPI: 1255743522
Provider Name (Legal Business Name): GINA GALIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SPLIT ROCK DR STE 5
CHERRY HILL NJ
08003-1244
US

IV. Provider business mailing address

283 DEWEY AVE
TOTOWA NJ
07512-2506
US

V. Phone/Fax

Practice location:
  • Phone: 833-494-6724
  • Fax:
Mailing address:
  • Phone: 973-809-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00637400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: