Provider Demographics
NPI:1497992820
Name:PUCCIARELLI, MARGO C (RPA-C)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:C
Last Name:PUCCIARELLI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PRUSAKOWSKI BLVD
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-3161
Mailing Address - Country:US
Mailing Address - Phone:856-304-3756
Mailing Address - Fax:
Practice Address - Street 1:355 GRAND STREET
Practice Address - Street 2:JERSEY CITY MEDICAL CENTER, DEPT OF SURGERY- 3 EAST
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00212000363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical