Provider Demographics
NPI:1316206147
Name:ANTHONY L GIORDANO,PH.D. LLC
Entity Type:Organization
Organization Name:ANTHONY L GIORDANO,PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-429-1444
Mailing Address - Street 1:300 MARLTON PIKE W
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3053
Mailing Address - Country:US
Mailing Address - Phone:856-429-1444
Mailing Address - Fax:856-429-1440
Practice Address - Street 1:300 MARLTON PIKE W
Practice Address - Street 2:SUITE 107
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3053
Practice Address - Country:US
Practice Address - Phone:856-429-1444
Practice Address - Fax:856-429-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00342800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7805501Medicaid
NJ7805501Medicaid