Healthcare Provider Details

I. General information

NPI: 1962325456
Provider Name (Legal Business Name): MARY NICOLE GIRGIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 APPLEGARTH RD
MONROE NJ
08831-3847
US

IV. Provider business mailing address

19 KENNETH AVE
OLD BRIDGE NJ
08857-2105
US

V. Phone/Fax

Practice location:
  • Phone: 609-655-3101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04498800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: