Provider Demographics
NPI:1477825487
Name:DUA, GIANCARLO SILVERIO (PTA)
Entity type:Individual
Prefix:MR
First Name:GIANCARLO
Middle Name:SILVERIO
Last Name:DUA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:CARLOS
Other - Middle Name:SILVERIO
Other - Last Name:DUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:213 SOUTH 8TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835
Mailing Address - Country:US
Mailing Address - Phone:908-967-4495
Mailing Address - Fax:
Practice Address - Street 1:458 ELIZABETH AVE
Practice Address - Street 2:SUITE 5385
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5110
Practice Address - Country:US
Practice Address - Phone:908-429-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00150900225200000X
NY003513-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant