Healthcare Provider Details

I. General information

NPI: 1134817711
Provider Name (Legal Business Name): NINA MARCHIONNE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N MAIN ST
GLASSBORO NJ
08028-1635
US

IV. Provider business mailing address

507 N MAIN ST
GLASSBORO NJ
08028-1635
US

V. Phone/Fax

Practice location:
  • Phone: 856-881-2525
  • Fax:
Mailing address:
  • Phone: 856-881-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00391800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: