Healthcare Provider Details

I. General information

NPI: 1235092057
Provider Name (Legal Business Name): STEPHANIE GERDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

1316 BRIGHT ST
HILLSIDE NJ
07205-2374
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-6511
  • Fax:
Mailing address:
  • Phone: 908-868-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15481100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: