Provider Demographics
NPI:1770666059
Name:MAURIELLO, MAGDALEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDALEN
Middle Name:S
Last Name:MAURIELLO
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 1:67 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:203-732-1256
Mailing Address - Fax:203-732-1539
Practice Address - Street 1:135 DIVISION ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2135
Practice Address - Country:US
Practice Address - Phone:203-308-2705
Practice Address - Fax:203-734-0137
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJH17172207R00000X
CT38841207R00000X, 207RC0200X, 207RP1001X
NJMA70201207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0144347Medicaid
NJ6818706Medicaid
NJ088346ZC8AMedicare PIN
NJ028091Medicare ID - Type Unspecified
NJ6818706Medicaid
NJ188912ZC79Medicare PIN