Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 38MC00470300 | NJ |
NPI | 1588799316 |
---|---|
Provider Name | Maurice Campanelli |
First Address | Ocean, NJ 07712-4552 |
Second Address | Ocean, NJ 07712-4552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |