=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316206147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY L GIORDANO,PH.D. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2012
-----------------------------------------------------
Last Update Date | 05/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 MARLTON PIKE W SUITE 107
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08002-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-429-1444
-----------------------------------------------------
Fax | 856-429-1440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 MARLTON PIKE W SUITE 107
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08002-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-429-1444
-----------------------------------------------------
Fax | 856-429-1440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTHONY L GIORDANO
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 856-429-1444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35SI00342800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------