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General NPI Number Information
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NPI Number | 1710177068
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Entity Type | Organization
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Legal Business Name | GAVIOTA CORPORATION
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 919 FRANKLIN AVE
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City | NEWARK
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State | NJ
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Zip | 07107-4801
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Country | US
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Telephone | 973-368-4130
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Fax |
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Provider Business Mailing Address
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Address Line | 559 BROADWAY APT 12
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City | NEWARK
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State | NJ
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Zip | 07104-4151
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Country | US
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Telephone | 973-368-4130
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Fax | 973-732-0023
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARIS L SILEGA
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Credential |
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Telephone | 973-368-4130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | NJ
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