Healthcare Provider Details

I. General information

NPI: 1609684778
Provider Name (Legal Business Name): GIL TAL APN-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 US HIGHWAY 46 W BLDG F
MOUNTAIN LAKES NJ
07046-1668
US

IV. Provider business mailing address

300 LITTLETON RD STE 301
PARSIPPANY NJ
07054-4841
US

V. Phone/Fax

Practice location:
  • Phone: 973-755-6636
  • Fax:
Mailing address:
  • Phone: 973-755-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15269000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: