Healthcare Provider Details

I. General information

NPI: 1487957528
Provider Name (Legal Business Name): GIULIA K CHURCH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GULIA K GIACALONE PA

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EAGLE AVE
OCEAN NJ
07712-7631
US

IV. Provider business mailing address

1200 EAGLE AVE
OCEAN NJ
07712-7631
US

V. Phone/Fax

Practice location:
  • Phone: 732-660-6200
  • Fax: 732-493-9981
Mailing address:
  • Phone: 732-660-6200
  • Fax: 732-493-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00241800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: