MEDICARE: MARISSA NUCCI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	40QA01518200	NJ
2	225100000X	Physical Therapist	40QA01518200	NJ

General Provider Information

NPI Number	:	1922435536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA NUCCI PT

Provider Business Mailing Address
First Line	:	601 HAMBURG TURNPIKE
Second Line	:	SUITE 101
City	:	WAYNE
State	:	NJ
Zip	:	07470-2049
Country	:	US
Telephone Number	:	973-942-4449
Fax Number	:	973-942-6339

Provider Business Practice Location Address
First Line	:	601 HAMBURG TURNPIKE
Second Line	:	SUITE 101
City	:	WAYNE
State	:	NJ
Zip	:	07470-2049
Country	:	US
Telephone Number	:	973-942-4449
Fax Number	:	973-839-3653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	03/12/2018

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