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General NPI Number Information
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NPI Number | 1942947965
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Entity Type | Organization
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Legal Business Name | SAMUEL PENNELLA MD INC
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Dates
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Enumeration Date | 05/20/2022
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 14 GLENNON FARM LN
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City | LEBANON
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State | NJ
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Zip | 08833-4504
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Country | US
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Telephone | 908-208-8926
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Fax |
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Provider Business Mailing Address
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Address Line | 615 GROVE ST
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City | CLIFTON
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State | NJ
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Zip | 07013-3846
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SAMUEL PENNELLA JR.
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Credential | MD
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Telephone | 908-208-8926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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