Provider Demographics
NPI:1558449702
Name:SCIARRILLO, ANDREA J (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:J
Last Name:SCIARRILLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NORTH AVE E
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2434
Mailing Address - Country:US
Mailing Address - Phone:908-272-5400
Mailing Address - Fax:908-272-9898
Practice Address - Street 1:301 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2434
Practice Address - Country:US
Practice Address - Phone:908-272-5400
Practice Address - Fax:908-272-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00621800111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU99184Medicare UPIN
NJ077521Medicare ID - Type Unspecified