Healthcare Provider Details

I. General information

NPI: 1053539106
Provider Name (Legal Business Name): MARIA E PARRELLA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PROSPECT ST
MADISON NJ
07940-2641
US

IV. Provider business mailing address

40 PROSPECT ST
MADISON NJ
07940-2641
US

V. Phone/Fax

Practice location:
  • Phone: 973-822-9323
  • Fax: 973-377-2468
Mailing address:
  • Phone: 973-822-9323
  • Fax: 973-377-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI01783600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: