Individual
NICOLINA PENTRELLI DERACO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
11 EAGLE ROCK AVE, EAST HANOVER, NJ 07936-3167
(197) 388-7900
Mailing address
11 EAGLE ROCK AVE, EAST HANOVER, NJ 07936-3167
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
022136-1
NY
Other
Enumeration date
05/31/2006
Last updated
08/13/2013
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