Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | C10009448 | DE |
N | 208000000X | Pediatrician | C7-0003807 | DE |
N | 208000000X | Pediatrician | MT190824 | PA |
Y | 2080P0205X | Pediatric Endocrinologist | 25MA09533900 | NJ |
NPI | 1376746990 |
---|---|
Provider Name | Dr. Michelle Marie Maresca |
First Address | Hackensack, NJ 07601-1915 |
Second Address | Hackensack, NJ 07601-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2007 |
Last Update Date | 18/12/2018 |