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General NPI Number Information
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NPI Number | 1053924910
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Entity Type | Individual
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Provider Name | JANICE MARIE GAURILOFF
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Gender | Female
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 32 COHOES RD
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City | WATERVLIET
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State | NY
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Zip | 12189-1811
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Country | US
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Telephone | 518-328-0430
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Fax |
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Provider Business Mailing Address
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Address Line | 611 BERYL WAY
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City | WATERVLIET
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State | NY
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Zip | 12189-2963
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Country | US
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Telephone | 518-698-5976
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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