Individual
MARISA PARISE PETRUCELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
175 HIGH ST, NEWTON, NJ 07860-1004
(973) 383-2121
Mailing address
11781 LEE JACKSON MEMORIAL HWY, SUITE 550, FAIRFAX, VA 22033-3309
(571) 777-5106
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
OT014334
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0412830
—
NJ
Enumeration date
06/22/2011
Last updated
08/07/2015
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