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General NPI Number Information
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NPI Number | 1063512457
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Entity Type | Individual
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Provider Name | MICHAEL CANNELLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 395 GRAND ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-4238
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Country | US
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Telephone | 201-915-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 135 W 29TH ST STE 204
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City | BAYONNE
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State | NJ
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Zip | 07002-1837
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Country | US
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Telephone | 201-858-7129
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Fax | 201-858-7129
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA05834400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA 05834400
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License Number State | NJ
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