MEDICARE: MARIA NUNZIA PETRUZZELLI WHNP-BC

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	363LW0102X	Women's Health Nurse Practitioner	26NJ00707000	NJ

General Provider Information

NPI Number	:	1942727003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA NUNZIA PETRUZZELLI WHNP-BC

Provider Business Mailing Address
First Line	:	130 KINDERKAMACK RD
Second Line	:
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661-1939
Country	:	US
Telephone Number	:	201-489-2727
Fax Number	:	201-489-5040

Provider Business Practice Location Address
First Line	:	130 KINDERKAMACK RD STE 300
Second Line	:
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661-1931
Country	:	US
Telephone Number	:	201-489-2727
Fax Number	:	201-489-5040

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

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	08/29/2017

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