Provider Demographics
NPI:1518132471
Name:RIDGEDALE FAMILY MEDICAL LLC
Entity Type:Organization
Organization Name:RIDGEDALE FAMILY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIUSEPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-887-0200
Mailing Address - Street 1:383 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1445
Mailing Address - Country:US
Mailing Address - Phone:973-887-0200
Mailing Address - Fax:973-887-4965
Practice Address - Street 1:383 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1445
Practice Address - Country:US
Practice Address - Phone:973-887-0200
Practice Address - Fax:973-887-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 05978207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF79041Medicare UPIN