Provider Demographics
NPI:1104695899
Name:MARZUCCO, STEPHANIE LYNN
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:MARZUCCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 HILLSBORO CT
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2914
Mailing Address - Country:US
Mailing Address - Phone:856-217-5889
Mailing Address - Fax:
Practice Address - Street 1:123 METRO BLVD
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-6101
Practice Address - Country:US
Practice Address - Phone:856-217-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program