Healthcare Provider Details

I. General information

NPI: 1497756936
Provider Name (Legal Business Name): JAMES D GIRARDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAGLE ROCK AVE SUITE 154
EAST HANOVER NJ
07936-3158
US

IV. Provider business mailing address

120 EAGLE ROCK AVE STE 154
EAST HANOVER NJ
07936-3168
US

V. Phone/Fax

Practice location:
  • Phone: 201-407-5145
  • Fax: 862-701-6444
Mailing address:
  • Phone: 201-407-5145
  • Fax: 862-701-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA07056000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: