Provider Demographics
NPI:1881755510
Name:SAMMARONE, MARCELLO (MD)
Entity type:Individual
Prefix:
First Name:MARCELLO
Middle Name:
Last Name:SAMMARONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 US HIGHWAY 46 STE 1
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2148
Mailing Address - Country:US
Mailing Address - Phone:973-917-3172
Mailing Address - Fax:973-917-3174
Practice Address - Street 1:1130 US HIGHWAY 46 STE 1
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2148
Practice Address - Country:US
Practice Address - Phone:973-917-3172
Practice Address - Fax:973-917-3174
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05745200208VP0000X, 207LP2900X, 208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7918909Medicaid
NJ010547CNKMedicare PIN
NJ7918909Medicaid