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General NPI Number Information
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NPI Number | 1518971068
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Entity Type | Individual
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Provider Name | MARIA BOCCALETTI VISCUSO MD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 2 HEDDEN TERRACE
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City | NORTH ARLINGTON
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State | NJ
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Zip | 07031-6109
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Country | US
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Telephone | 201-991-5353
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Fax | 201-991-0587
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Provider Business Mailing Address
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Address Line | 85 S JEFFERSON ST STE. 1
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City | ORANGE
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State | NJ
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Zip | 07050-1562
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Country | US
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Telephone | 973-677-3466
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Fax | 973-677-2362
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA04319400
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License Number State | NJ
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