Provider Demographics
NPI:1346902996
Name:GIOCONDA AESTHETICS INC
Entity Type:Organization
Organization Name:GIOCONDA AESTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:908-670-3322
Mailing Address - Street 1:1350 15TH ST APT 15M
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2030
Mailing Address - Country:US
Mailing Address - Phone:908-670-3322
Mailing Address - Fax:
Practice Address - Street 1:1350 15TH ST APT 15M
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2030
Practice Address - Country:US
Practice Address - Phone:908-670-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health