Provider Demographics
NPI:1013119973
Name:ADDESA, MARIE ANN (APN, DC)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ANN
Last Name:ADDESA
Suffix:
Gender:F
Credentials:APN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 MAIN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4962
Mailing Address - Country:US
Mailing Address - Phone:973-778-2300
Mailing Address - Fax:973-778-2311
Practice Address - Street 1:647 MAIN AVE STE 202
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4962
Practice Address - Country:US
Practice Address - Phone:973-778-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350691363LF0000X
FLAPRN11027588363LF0000X
NJ26NJ14914900363LF0000X
NJ38MC00467000111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily