Provider Demographics
NPI:1417633256
Name:AUTERA, MARISA
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:AUTERA
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 1:127 HORNSBY ST
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1945
Mailing Address - Country:US
Mailing Address - Phone:732-770-3548
Mailing Address - Fax:
Practice Address - Street 1:80 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5727
Practice Address - Country:US
Practice Address - Phone:732-784-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02178000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation