Provider Demographics
NPI:1750607321
Name:FUNICIELLO, MARCO (DO)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:FUNICIELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EWING ST
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2757
Mailing Address - Country:US
Mailing Address - Phone:609-454-0760
Mailing Address - Fax:609-454-0761
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:BUILDING A1
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-454-0760
Practice Address - Fax:609-454-0761
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08763500208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation