Healthcare Provider Details

I. General information

NPI: 1427348580
Provider Name (Legal Business Name): ORIANA PETRUOLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 11/04/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 402
HACKENSACK NJ
07601-1941
US

IV. Provider business mailing address

20 PROSPECT AVE STE 402
HACKENSACK NJ
07601-1941
US

V. Phone/Fax

Practice location:
  • Phone: 519-963-0945
  • Fax:
Mailing address:
  • Phone: 551-996-3094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA10939400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: