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General NPI Number Information
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NPI Number | 1083507982
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Entity Type | Organization
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Legal Business Name | GIA19
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 1322 ROUTE 72 W STE 202A
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City | STAFFORD TOWNSHIP
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State | NJ
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Zip | 08050-2486
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Country | US
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Telephone | 561-676-1634
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Fax |
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Provider Business Mailing Address
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Address Line | 1322 ROUTE 72 W STE 202A
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2486
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Country | US
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Telephone | 561-676-1634
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL MIRANDA
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Credential | LCADC, CCS
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Telephone | 609-759-0514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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