Provider Demographics
NPI:1295804102
Name:WALLINGTON CLINIC LLC
Entity type:Organization
Organization Name:WALLINGTON CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GIARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-471-1212
Mailing Address - Street 1:46 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-1219
Mailing Address - Country:US
Mailing Address - Phone:973-471-1212
Mailing Address - Fax:973-471-3311
Practice Address - Street 1:46 UNION BLVD
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1219
Practice Address - Country:US
Practice Address - Phone:973-471-1212
Practice Address - Fax:973-471-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ109179Medicare PIN