Provider Demographics
NPI:1518027622
Name:SANTORELLI, MARY C (APN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:SANTORELLI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:PANTIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 LINDSLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4455
Mailing Address - Country:US
Mailing Address - Phone:973-451-0246
Mailing Address - Fax:973-451-0166
Practice Address - Street 1:99 BEAUVOIR AVENUE
Practice Address - Street 2:SUITE 46-48 BEAUVOIR
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07902-0220
Practice Address - Country:US
Practice Address - Phone:888-247-1400
Practice Address - Fax:973-451-0166
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO7537400163WP0809X
NJ26NC07537400364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0130893OtherNJ FAMILYCARE/MEDICAID