Provider Demographics
NPI:1457035362
Name:CORTEZ, GIANCARLO DAVID (PA)
Entity Type:Individual
Prefix:MR
First Name:GIANCARLO
Middle Name:DAVID
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:247 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1544
Mailing Address - Country:US
Mailing Address - Phone:201-824-3310
Mailing Address - Fax:
Practice Address - Street 1:550 NEWARK AVE STE 307
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1353
Practice Address - Country:US
Practice Address - Phone:201-418-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00774900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant