Provider Demographics
NPI:1912976267
Name:PETRUCELLI, ROBERT CORTESE (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CORTESE
Last Name:PETRUCELLI
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Gender:M
Credentials:MD, PA
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Mailing Address - Street 1:66 SUNSET STRIP
Mailing Address - Street 2:STE 208
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:973-252-0333
Mailing Address - Fax:973-252-0220
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:STE 208
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:973-252-0333
Practice Address - Fax:973-252-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2014-03-31
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03332600174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110942OtherMEDICARE PTAN