Individual
TINA M PETILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
340 EAST NORTHFIELD ROAD, SUITE 2E, LIVINGSTON, NJ 07039-4892
(973) 533-0001
(973) 716-0306
Mailing address
340 E NORTHFIELD RD STE 2E, LIVINGSTON, NJ 07039-4892
(973) 533-0001
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
44503
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7413505
—
NJ
Enumeration date
07/12/2006
Last updated
03/30/2011
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