MEDICARE: DR. MARC ANTONY GIRONDA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	35SI00416100	NJ

General Provider Information

NPI Number	:	1194832501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC ANTONY GIRONDA PSY.D.

Provider Business Mailing Address
First Line	:	60 KNICKERBOCKER AVE
Second Line	:
City	:	DOVER
State	:	NJ
Zip	:	07801-4823
Country	:	US
Telephone Number	:	973-537-9279
Fax Number	:

Provider Business Practice Location Address
First Line	:	513 W MOUNT PLEASANT AVE
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1710
Country	:	US
Telephone Number	:	973-533-1195
Fax Number	:	973-533-1305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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