Provider Demographics
NPI:1861636151
Name:CLAUDIA M. PETRUNCIO DO
Entity Type:Organization
Organization Name:CLAUDIA M. PETRUNCIO DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETRUNCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-488-6785
Mailing Address - Street 1:2201 CHAPEL AVE W
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2048
Mailing Address - Country:US
Mailing Address - Phone:856-488-6785
Mailing Address - Fax:856-488-6495
Practice Address - Street 1:2201 CHAPEL AVE W
Practice Address - Street 2:SUITE 106
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2048
Practice Address - Country:US
Practice Address - Phone:856-488-6785
Practice Address - Fax:856-488-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB4695500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ033532Medicare PIN