Healthcare Provider Details

I. General information

NPI: 1407951197
Provider Name (Legal Business Name): ANNE C SCARCELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

110 WILLIAM AVE
STATEN ISLAND NY
10308-3160
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5258
Mailing address:
  • Phone: 908-647-0180
  • Fax: 908-604-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00063000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF-333790-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: