MEDICARE: MARIA BOCCALETTI VISCUSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA04319400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1K9721	OTHER		HEALTHNET
2	4219773	OTHER	NJ	AETNA
3	P843368	OTHER		OXFORD
4	2594703	OTHER		GHI
5	P843368	OTHER		AMERIHEALTH
6	MV033S8610	OTHER	NY	EMPIRE BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518971068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA BOCCALETTI VISCUSO MD

Provider Business Mailing Address
First Line	:	85 S JEFFERSON ST
Second Line	:	STE. 1
City	:	ORANGE
State	:	NJ
Zip	:	07050-1562
Country	:	US
Telephone Number	:	973-677-3466
Fax Number	:	973-677-2362

Provider Business Practice Location Address
First Line	:	2 HEDDEN TERRACE
Second Line	:
City	:	NORTH ARLINGTON
State	:	NJ
Zip	:	07031-6109
Country	:	US
Telephone Number	:	201-991-5353
Fax Number	:	201-991-0587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	12/28/2023

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