1699836932 NPI number — DR. MARISSA NICOLE PELLEGRINO PH.D.

Table of content: DR. MARISSA NICOLE PELLEGRINO PH.D. (NPI 1699836932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699836932 NPI number — DR. MARISSA NICOLE PELLEGRINO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELLEGRINO
Provider First Name:
MARISSA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAFARELLA
Provider Other First Name:
MARISSA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699836932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 W SHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENNINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08534-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-737-6896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CANAL POINTE BLVD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-7169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-895-1070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006

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: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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