=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437240553
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN A CERRITELLI MD DSC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 02/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 FRANKLIN AVE
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109-3532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-751-4477
-----------------------------------------------------
Fax | 973-751-4444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 FRANKLIN AVE STE 501
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109-3565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-751-4477
-----------------------------------------------------
Fax | 973-751-4444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25MA06042000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MA60420
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------