Provider Demographics
NPI:1477712636
Name:FIORILLO, MARC ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTHONY
Last Name:FIORILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:ANTHONY
Other - Last Name:FIORILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:140 SYLVAN AVE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2514
Mailing Address - Country:US
Mailing Address - Phone:201-945-6564
Mailing Address - Fax:201-461-9038
Practice Address - Street 1:140 SYLVAN AVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2514
Practice Address - Country:US
Practice Address - Phone:201-945-6564
Practice Address - Fax:201-461-9038
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08412100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0218227Medicaid
NJ0218227Medicaid