Provider Demographics
NPI:1902449952
Name:SIGNORELLI, GINA (IBCLC, RDN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:SIGNORELLI
Suffix:
Gender:F
Credentials:IBCLC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MALVERN PL
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2555
Mailing Address - Country:US
Mailing Address - Phone:201-410-5662
Mailing Address - Fax:
Practice Address - Street 1:27 MALVERN PL
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2555
Practice Address - Country:US
Practice Address - Phone:201-410-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133V00000X
NJL-68704174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered