Individual
MRS. TARA ANIELA NICOLETTA-GAJANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1610 ROUTE 88 STE 203, BRICK, NJ 08724-3018
(732) 840-3339
Mailing address
3600 ROUTE 66 FL 3, NEPTUNE, NJ 07753-2645
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
25MP000542
NJ
Other
Enumeration date
04/17/2008
Last updated
03/06/2024
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