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General NPI Number Information
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NPI Number | 1811161557
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Entity Type | Organization
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Legal Business Name | TINA M. PETILLO DO PA
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 340 E NORTHFIELD RD SUITE 2E
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4892
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Country | US
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Telephone | 973-533-0001
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Fax | 973-716-0306
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Provider Business Mailing Address
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Address Line | 340 E NORTHFIELD RD SUITE 2E
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4892
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Country | US
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Telephone | 973-533-0001
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Fax | 973-716-0306
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Authorized Official
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Title or Position | DOCTOR
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Name | TINA M PETILLO
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Credential | D.O.
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Telephone | 973-533-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MB04450300
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License Number State | NJ
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