Individual
MICHAEL COLUCCIELLO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
509 S LENOLA RD STE 11A, MOORESTOWN, NJ 08057-1561
(856) 234-0258
(856) 727-9518
Mailing address
509 S LENOLA RD STE 11A, MOORESTOWN, NJ 08057-1561
(856) 234-0258
(856) 727-9518
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25MA06592100
NJ
207W00000X
Ophthalmology Physician
MD041676L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7315902
—
NJ
Enumeration date
07/07/2005
Last updated
04/12/2021
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