Provider Demographics
NPI:1780275891
Name:GIORDANO, GENNA LYNN (PA)
Entity type:Individual
Prefix:
First Name:GENNA
Middle Name:LYNN
Last Name:GIORDANO
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:137 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5519
Mailing Address - Country:US
Mailing Address - Phone:718-619-0842
Mailing Address - Fax:
Practice Address - Street 1:100 CRAIG RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8787
Practice Address - Country:US
Practice Address - Phone:732-414-6506
Practice Address - Fax:732-414-6507
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026367363A00000X
NJ25MP00783400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty