Provider Demographics
NPI:1053924910
Name:GAURILOFF, JANICE MARIE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:GAURILOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BERYL WAY
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2963
Mailing Address - Country:US
Mailing Address - Phone:518-698-5976
Mailing Address - Fax:
Practice Address - Street 1:32 COHOES RD
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-1811
Practice Address - Country:US
Practice Address - Phone:518-328-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency