Healthcare Provider Details

I. General information

NPI: 1033526777
Provider Name (Legal Business Name): GARIS SILEGA DR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S ORANGE AVE APT 1405
NEWARK NJ
07103-2766
US

IV. Provider business mailing address

180 S ORANGE AVE APT 1405
NEWARK NJ
07103-2766
US

V. Phone/Fax

Practice location:
  • Phone: 973-900-6397
  • Fax: 877-991-4799
Mailing address:
  • Phone: 973-900-6397
  • Fax: 877-991-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: