Provider Demographics
NPI:1477873214
Name:GURCIULLO, ANDREA MARIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIE
Last Name:GURCIULLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 HIGH MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2664
Mailing Address - Country:US
Mailing Address - Phone:516-425-4575
Mailing Address - Fax:516-568-7789
Practice Address - Street 1:475 HIGH MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2664
Practice Address - Country:US
Practice Address - Phone:516-425-4575
Practice Address - Fax:516-568-7789
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00132-00171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist