Provider Demographics
NPI:1417679184
Name:PAOLELLA, MARISA ROSE (PA)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ROSE
Last Name:PAOLELLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 GARDEN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4107
Mailing Address - Country:US
Mailing Address - Phone:908-328-3328
Mailing Address - Fax:
Practice Address - Street 1:174 EDISON RD
Practice Address - Street 2:
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849-2217
Practice Address - Country:US
Practice Address - Phone:973-663-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00734200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical