Provider Demographics
NPI:1588799316
Name:CAMPANELLI, MAURICE (DC)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:CAMPANELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4552
Mailing Address - Country:US
Mailing Address - Phone:732-775-6613
Mailing Address - Fax:732-775-3729
Practice Address - Street 1:3211 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4552
Practice Address - Country:US
Practice Address - Phone:732-775-6613
Practice Address - Fax:732-775-3729
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00470300111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCA 894225Medicare ID - Type Unspecified