Provider Demographics
NPI:1740453471
Name:PETRUCCI, JAMES CHRISTOPHER (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:PETRUCCI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-0617
Mailing Address - Country:US
Mailing Address - Phone:609-624-9003
Mailing Address - Fax:609-624-9002
Practice Address - Street 1:2041 N ROUTE 9
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1162
Practice Address - Country:US
Practice Address - Phone:609-624-9003
Practice Address - Fax:609-624-9002
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB083550002080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0201693Medicaid