Provider Demographics
NPI:1952528507
Name:MAURIELLO JR, GERALD A JR (DPM, MA, LAC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:MAURIELLO JR
Suffix:JR
Gender:M
Credentials:DPM, MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-1409
Mailing Address - Country:US
Mailing Address - Phone:908-475-8750
Mailing Address - Fax:908-475-8755
Practice Address - Street 1:500 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1409
Practice Address - Country:US
Practice Address - Phone:908-475-8750
Practice Address - Fax:908-475-8755
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006090213ES0103X, 213E00000X
NJ25MD00291100213ES0103X
NJ37AC00728900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1952528507OtherBRAVO
PA1952528507OtherHORIZON BCBS OF NEW JERSEY
PA1022940640001Medicaid
PA6917669OtherAETNA HMO
PA102294064002Medicaid
PA10229406401OtherAMERICHOICE
PA1952528507OtherHEALTH PARTNERS
PA9757088OtherAETNA PPO