Provider Demographics
NPI:1396059507
Name:MARYANN ALESSIO DO PA
Entity type:Organization
Organization Name:MARYANN ALESSIO DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALESSIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-667-8889
Mailing Address - Street 1:349 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2738
Mailing Address - Country:US
Mailing Address - Phone:973-667-8889
Mailing Address - Fax:973-667-5665
Practice Address - Street 1:349 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2738
Practice Address - Country:US
Practice Address - Phone:973-667-8889
Practice Address - Fax:973-667-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB63953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ183882Medicare PIN