Provider Demographics
NPI:1639847890
Name:GABRIELLA KELLISH
Entity type:Organization
Organization Name:GABRIELLA KELLISH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/SC SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-489-7884
Mailing Address - Street 1:75 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2025
Mailing Address - Country:US
Mailing Address - Phone:973-281-8267
Mailing Address - Fax:973-893-9479
Practice Address - Street 1:75 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2025
Practice Address - Country:US
Practice Address - Phone:973-281-8267
Practice Address - Fax:973-893-9479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management