Healthcare Provider Details

I. General information

NPI: 1194460618
Provider Name (Legal Business Name): ENZA N MARUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 RECKLESS PL
RED BANK NJ
07701-1750
US

IV. Provider business mailing address

114 SAGAMORE AVE
OCEANPORT NJ
07757-1658
US

V. Phone/Fax

Practice location:
  • Phone: 732-219-9002
  • Fax:
Mailing address:
  • Phone: 732-963-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: