Provider Demographics
NPI:1922116326
Name:MARELLA, GREGG GERARD (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:GERARD
Last Name:MARELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1503
Mailing Address - Country:US
Mailing Address - Phone:973-543-6505
Mailing Address - Fax:973-543-2967
Practice Address - Street 1:19 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1503
Practice Address - Country:US
Practice Address - Phone:973-543-6505
Practice Address - Fax:973-543-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG41505Medicare UPIN