Provider Demographics
NPI:1437240553
Name:CERRITELLI, JOHN A (MD DSC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:CERRITELLI
Suffix:
Gender:M
Credentials:MD DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANKLIN AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3565
Mailing Address - Country:US
Mailing Address - Phone:973-751-4477
Mailing Address - Fax:973-751-4444
Practice Address - Street 1:5 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3532
Practice Address - Country:US
Practice Address - Phone:973-751-4477
Practice Address - Fax:973-751-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06042000207R00000X
NJMA60420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ766334Medicare ID - Type Unspecified
NJF78304Medicare UPIN