Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB06286100 | NJ |
N | 207QA0401X | Family Doctor - Addiction Medicine | 2014416 | MD |
NPI | 1518920552 |
---|---|
Provider Name | Dr. David T Gigliotti |
First Address | Marlton, NJ 08053-4112 |
Second Address | Berlin, NJ 08009-2032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 22/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8014906 | (05) | NJ |
G21129 | (02) | NJ |
P00447480 | RAIL ROAD MEDICARE (01) |