Provider Demographics
NPI:1083507982
Name:GIA19
Entity type:Organization
Organization Name:GIA19
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC, CCS
Authorized Official - Phone:609-759-0514
Mailing Address - Street 1:240 MATHISTOWN RD UNIT 212
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-4062
Mailing Address - Country:US
Mailing Address - Phone:561-676-1634
Mailing Address - Fax:
Practice Address - Street 1:240 MATHISTOWN RD UNIT 212
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-4062
Practice Address - Country:US
Practice Address - Phone:609-759-0514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder