Provider Demographics
NPI:1922435536
Name:NUCCI, MARISSA (PT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:NUCCI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:RUSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:601 HAMBURG TURNPIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2049
Mailing Address - Country:US
Mailing Address - Phone:973-942-4449
Mailing Address - Fax:973-942-6339
Practice Address - Street 1:601 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2049
Practice Address - Country:US
Practice Address - Phone:973-942-4449
Practice Address - Fax:973-839-3653
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01518200208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation