Provider Demographics
NPI:1356317796
Name:HARFST, GIGETTE COLLAZO (OD)
Entity Type:Individual
Prefix:DR
First Name:GIGETTE
Middle Name:COLLAZO
Last Name:HARFST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GIGETTE
Other - Middle Name:
Other - Last Name:COLLAZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:15 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1916
Mailing Address - Country:US
Mailing Address - Phone:908-689-0240
Mailing Address - Fax:908-689-0676
Practice Address - Street 1:15 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1916
Practice Address - Country:US
Practice Address - Phone:908-689-0240
Practice Address - Fax:908-689-0676
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-26
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00514000152W00000X
VA0601002125152W00000X
VA0618000536152W00000X
NJ27OM00091000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
003008OtherMEDICARE
NJ0116157Medicaid
NJ0116157Medicaid