Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 25MA10146800 | NJ |
NPI | 1043449671 |
---|---|
Provider Name | Dr. Mario Charles Colletti |
First Address | Wayne, NJ 07470-3812 |
Second Address | Paterson, NJ 07503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 22/06/2018 |