Healthcare Provider Details

I. General information

NPI: 1740453471
Provider Name (Legal Business Name): JAMES CHRISTOPHER PETRUCCI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 N ROUTE 9
CAPE MAY COURT HOUSE NJ
08210-1162
US

IV. Provider business mailing address

PO BOX 617
OCEAN VIEW NJ
08230-0617
US

V. Phone/Fax

Practice location:
  • Phone: 609-624-9003
  • Fax: 609-624-9002
Mailing address:
  • Phone: 609-624-9003
  • Fax: 609-624-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB08355000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number25MB08355000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: