Individual
ANDREA L IANNUZZELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO, FACOI
Contact information
Practice address
1474 TANYARD ROAD, SUITE C100, SEWELL, NJ 08080
(855) 932-7476
(856) 566-6384
Mailing address
1474 TANYARD ROAD, SUITE C100, SEWELL, NJ 08080
(855) 932-7476
(856) 566-6384
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA06796400
NJ
207R00000X
Internal Medicine Physician
25MB06796400
NJ
207RN0300X
Nephrology Physician
25MA06796400
NJ
207RN0300X
Nephrology Physician
25MB06796400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8577501
—
NJ
Enumeration date
08/12/2005
Last updated
03/14/2024
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