Provider Demographics
NPI:1427015130
Name:DURELLI, GLORIA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:SUE
Last Name:DURELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3144
Mailing Address - Country:US
Mailing Address - Phone:856-848-2332
Mailing Address - Fax:856-848-5955
Practice Address - Street 1:297 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3144
Practice Address - Country:US
Practice Address - Phone:856-848-2332
Practice Address - Fax:856-848-5955
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA044017208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C59824Medicare UPIN