Healthcare Provider Details

I. General information

NPI: 1619490083
Provider Name (Legal Business Name): ALLYSON PETRUZZIELLO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 MARKET ST STE 2
SADDLE BROOK NJ
07663-6026
US

IV. Provider business mailing address

703 MAIN ST
PATERSON NJ
07503-2691
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-4797
  • Fax:
Mailing address:
  • Phone: 973-754-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00696000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00696000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: