Provider Demographics
NPI:1891211959
Name:GIANGRANDE, JACLYN DANIELLE (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:DANIELLE
Last Name:GIANGRANDE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 JORALEMON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2167
Mailing Address - Country:US
Mailing Address - Phone:973-517-1010
Mailing Address - Fax:
Practice Address - Street 1:160 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3075
Practice Address - Country:US
Practice Address - Phone:973-667-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01749600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist