Provider Demographics
NPI:1013221050
Name:GEDAKA, GERALYN M (APN)
Entity type:Individual
Prefix:
First Name:GERALYN
Middle Name:M
Last Name:GEDAKA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 W SHERMAN AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6937
Mailing Address - Country:US
Mailing Address - Phone:631-534-7246
Mailing Address - Fax:856-457-5681
Practice Address - Street 1:994 W SHERMAN AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6937
Practice Address - Country:US
Practice Address - Phone:609-383-0200
Practice Address - Fax:631-534-7246
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00294700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00294700OtherDIVISION OF CONSUMER AFFAIRS
NJ26NO11108000OtherDIVISION OF CONSUMER AFFAIRS