Provider Demographics
NPI:1346333879
Name:MARESCA, ANN (PA C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MARESCA
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 HIGHWAY 34 STE 102
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9738
Mailing Address - Country:US
Mailing Address - Phone:732-345-1180
Mailing Address - Fax:732-530-4476
Practice Address - Street 1:1967 STATE ROUTE 34 STE 102
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-345-1180
Practice Address - Fax:732-530-4476
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00077600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P46867Medicare UPIN