Provider Demographics
NPI:1821008327
Name:L. GUALBERTI GIRGIS MD AND J. GUALBERTI MD
Entity Type:Organization
Organization Name:L. GUALBERTI GIRGIS MD AND J. GUALBERTI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUALBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-431-1520
Mailing Address - Street 1:9 PROFESSIONAL CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2426
Mailing Address - Country:US
Mailing Address - Phone:732-431-1520
Mailing Address - Fax:732-431-1567
Practice Address - Street 1:9 PROFESSIONAL CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2426
Practice Address - Country:US
Practice Address - Phone:732-431-1520
Practice Address - Fax:732-431-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA075687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062561Medicaid
NJ0062561Medicaid
NJ0062561Medicaid