Provider Demographics
NPI:1841599651
Name:ROEHNELT, ALESSIA CARLUCCIO (MD)
Entity Type:Individual
Prefix:
First Name:ALESSIA
Middle Name:CARLUCCIO
Last Name:ROEHNELT
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 1:62 SOUTH FULLERTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042
Mailing Address - Country:US
Mailing Address - Phone:973-559-6780
Mailing Address - Fax:973-780-9688
Practice Address - Street 1:62 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2676
Practice Address - Country:US
Practice Address - Phone:973-559-6780
Practice Address - Fax:973-470-8188
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266806207R00000X
390200000X
NJ25MA10096200207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program