Provider Demographics
NPI:1861093221
Name:SOREZZA, GIACOMINA CARMELA (FNP)
Entity type:Individual
Prefix:
First Name:GIACOMINA
Middle Name:CARMELA
Last Name:SOREZZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 BETSY ROSS DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4223
Mailing Address - Country:US
Mailing Address - Phone:732-558-0116
Mailing Address - Fax:
Practice Address - Street 1:193 ROUTE 9 STE 2A
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3016
Practice Address - Country:US
Practice Address - Phone:732-558-0116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345765363LF0000X
NJ26NJ01127100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY345765Medicaid