Provider Demographics
NPI:1770175069
Name:FOSS, GISELLE (DC)
Entity type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:
Last Name:FOSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1141
Mailing Address - Country:US
Mailing Address - Phone:201-247-4524
Mailing Address - Fax:
Practice Address - Street 1:18 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1141
Practice Address - Country:US
Practice Address - Phone:201-247-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00780800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No111N00000XChiropractic ProvidersChiropractor