Healthcare Provider Details

I. General information

NPI: 1912117821
Provider Name (Legal Business Name): MARIANNE CIFELLI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 BROAD ST STE 100
CLIFTON NJ
07013-3346
US

IV. Provider business mailing address

1135 BROAD ST STE 100
CLIFTON NJ
07013-3346
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-0103
  • Fax: 973-256-8066
Mailing address:
  • Phone: 973-256-0103
  • Fax: 973-256-8066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number22DI02270800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02270800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: