Provider Demographics
NPI:1326109844
Name:SCLAFANI, GINA (OD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:SCLAFANI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:SCLAFANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3333 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8503
Mailing Address - Country:US
Mailing Address - Phone:732-780-5771
Mailing Address - Fax:732-780-1511
Practice Address - Street 1:3333 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8503
Practice Address - Country:US
Practice Address - Phone:732-780-5771
Practice Address - Fax:732-780-1511
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA04882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ168347ZE84Medicare PIN