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General NPI Number Information
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NPI Number | 1043506637
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Entity Type | Individual
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Provider Name | MARISA PARISE PETRUCELLI D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 175 HIGH ST
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City | NEWTON
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State | NJ
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Zip | 07860-1004
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Country | US
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Telephone | 973-383-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 11781 LEE JACKSON MEMORIAL HWY SUITE 550
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City | FAIRFAX
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State | VA
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Zip | 22033-3309
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Country | US
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Telephone | 571-777-5106
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Fax | 703-766-9725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | OT014334
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License Number State | PA
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