Provider Demographics
NPI:1881218907
Name:LATELLA, VICTORIA ANNE (MS, MBS, PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE
Last Name:LATELLA
Suffix:
Gender:F
Credentials:MS, MBS, PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1 JOHN F KENNEDY BLVD APT 9E
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6906
Mailing Address - Country:US
Mailing Address - Phone:201-874-8167
Mailing Address - Fax:
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:973-251-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant