Healthcare Provider Details

I. General information

NPI: 1518027622
Provider Name (Legal Business Name): MARY C SANTORELLI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MARY PANTIGO

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVENUE SUITE 46-48 BEAUVOIR
SUMMIT NJ
07902-0220
US

IV. Provider business mailing address

25 LINDSLEY DR SUITE 100
MORRISTOWN NJ
07960-4455
US

V. Phone/Fax

Practice location:
  • Phone: 888-247-1400
  • Fax: 973-451-0166
Mailing address:
  • Phone: 973-451-0246
  • Fax: 973-451-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NO7537400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number26NC07537400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: