Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 26NN09058900 | NJ |
NPI | 1578508891 |
---|---|
Provider Name | Marion R Massimiano |
First Address | Ventnor City, NJ 08406-1430 |
Second Address | Pomona, NJ 08240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/07/2007 |