Provider Demographics
NPI:1730116690
Name:MASCELLINO, ANN MARIE MADALINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN MARIE
Middle Name:MADALINE
Last Name:MASCELLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 ROUTE 23 STE 300
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7520
Mailing Address - Country:US
Mailing Address - Phone:973-942-4778
Mailing Address - Fax:973-942-7020
Practice Address - Street 1:1680 ROUTE 23 STE 300
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7520
Practice Address - Country:US
Practice Address - Phone:973-942-4778
Practice Address - Fax:973-942-7020
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA714152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
04512BLJMedicare ID - Type Unspecified
NJH35911Medicare UPIN