Healthcare Provider Details

I. General information

NPI: 1881781672
Provider Name (Legal Business Name): RENEE M COCHRANE PUCCIARELLI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WASHINGTON AVENUE
IRVINGTON NJ
07111
US

IV. Provider business mailing address

320 SOUTH MAIN STREET 2ND FLR
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 973-399-5000
  • Fax: 973-275-2630
Mailing address:
  • Phone: 908-387-6120
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI02316300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: