Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00475900 | NJ |
NPI | 1003845157 |
---|---|
Provider Name | Dr. Pasquale Pucciarelli |
First Address | Linden, NJ 07036-5200 |
Second Address | Linden, NJ 07036-5200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
867642RL9 | (02) | NJ |