Healthcare Provider Details

I. General information

NPI: 1376422147
Provider Name (Legal Business Name): OLIVIA CIANCIOTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVE BLDG 1200, FL 2
EGG HARBOR TOWNSHIP NJ
08234
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE BLDG 1200, FL 2
EGG HARBOR TOWNSHIP NJ
08234-5549
US

V. Phone/Fax

Practice location:
  • Phone: 609-833-4455
  • Fax: 609-445-0021
Mailing address:
  • Phone: 609-833-4455
  • Fax: 609-445-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00966200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: