Healthcare Provider Details

I. General information

NPI: 1598776056
Provider Name (Legal Business Name): MARISA CIUFALO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

715 ROUTE 10 EAST
RANDOLPH NJ
07869
US

IV. Provider business mailing address

715 ROUTE 10 EAST
RANDOLPH NJ
07869
US

V. Phone/Fax

Practice location:
  • Phone: 973-328-9200
  • Fax: 973-328-9144
Mailing address:
  • Phone: 973-328-9200
  • Fax: 973-328-9144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA69769
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: