Provider Demographics
NPI:1962615245
Name:SCHIRALDI, GERARD (DMD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:SCHIRALDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 10TH ST
Mailing Address - Street 2:#4
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2921
Mailing Address - Country:US
Mailing Address - Phone:201-319-1600
Mailing Address - Fax:201-319-1473
Practice Address - Street 1:714 10TH ST
Practice Address - Street 2:#4
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2921
Practice Address - Country:US
Practice Address - Phone:201-319-1600
Practice Address - Fax:201-319-1473
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012255001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics