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General NPI Number Information
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NPI Number | 1275707721
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Entity Type | Individual
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Provider Name | JAMES G. IANNUCCI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 24 OSBORN LN
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City | BRIDGETON
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State | NJ
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Zip | 08302-4528
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Country | US
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Telephone | 856-455-8745
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Fax | 856-451-6675
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Provider Business Mailing Address
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Address Line | 24 OSBORN LN
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City | BRIDGETON
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State | NJ
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Zip | 08302-4528
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Country | US
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Telephone | 856-455-8745
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Fax | 856-451-6675
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | MA019173
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License Number State | NJ
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