1497992820 NPI number — MARGO C PUCCIARELLI RPA-C

Table of content: MARGO C PUCCIARELLI RPA-C (NPI 1497992820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497992820 NPI number — MARGO C PUCCIARELLI RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUCCIARELLI
Provider First Name:
MARGO
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497992820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 PRUSAKOWSKI BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARLIN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08859-3161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-304-3756
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 GRAND STREET
Provider Second Line Business Practice Location Address:
JERSEY CITY MEDICAL CENTER, DEPT OF SURGERY- 3 EAST
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-915-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  25MP00212000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)