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NPI Code Detail

MEDICARE: GABRIELLE TANTILLO

MEDICARE: GABRIELLE TANTILLO
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
12255A2300XAthletic Trainer
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1437803186
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE TANTILLO
Provider Business Mailing Address
First Line : 90 COMPTON AVE
Second Line :
City : HAZLET TOWNSHIP
State : NJ
Zip : 07734-3111
Country : US
Telephone Number : 732-778-0587
Fax Number :
Provider Business Practice Location Address
First Line : 123 METRO BLVD
Second Line :
City : NUTLEY
State : NJ
Zip : 07110-6101
Country : US
Telephone Number : 973-761-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2022
Last Update Date : 02/10/2022

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Directions to “ GABRIELLE TANTILLO ” Practice Location

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