Provider Demographics
NPI:1184790636
Name:MARCHESE, LORENZO E JR (DC)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:E
Last Name:MARCHESE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOWE AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1307
Mailing Address - Country:US
Mailing Address - Phone:973-667-2342
Mailing Address - Fax:973-667-7246
Practice Address - Street 1:3 HOWE AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1307
Practice Address - Country:US
Practice Address - Phone:973-667-2342
Practice Address - Fax:973-667-7246
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ489637Medicare PIN
NJU18217Medicare UPIN