Provider Demographics
NPI:1871020917
Name:NUNZIATO-VIRGA, STEPHANIE ROSE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROSE
Last Name:NUNZIATO-VIRGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-3611
Mailing Address - Country:US
Mailing Address - Phone:973-557-5762
Mailing Address - Fax:
Practice Address - Street 1:75 CLAREMONT RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2262
Practice Address - Country:US
Practice Address - Phone:908-766-2800
Practice Address - Fax:908-524-1246
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000845170300000X
CT131170300000X
NJ25MJ00020500170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS