Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MA044506 | NJ |
Y | 111NI0900X | Internist | MA044506 | NJ |
N | 207RA0401X | Internist - Addiction Medicine | XC8698168 | NJ |
NPI | 1063520484 |
---|---|
Provider Name | Louis Citarelli |
First Address | Newark, NJ 07101-5151 |
Second Address | Nutley, NJ 07110-3820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 17/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107094 | (02) | NJ |