Provider Demographics
NPI:1679723969
Name:PICARIELLO, GLORIA P (APN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:P
Last Name:PICARIELLO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7549
Mailing Address - Country:US
Mailing Address - Phone:732-255-0015
Mailing Address - Fax:
Practice Address - Street 1:62 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2312
Practice Address - Country:US
Practice Address - Phone:908-725-8880
Practice Address - Fax:908-725-5656
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04351300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health