Basic Information
| Provider Information | |||||||||
| NPI: | 1578508891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASSIMIANO | ||||||||
| FirstName: | MARION | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 N LITTLE ROCK AVE | ||||||||
| Address2: | |||||||||
| City: | VENTNOR CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084061430 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 JIMMIE LEEDS ROAD | ||||||||
| Address2: | ATLANTICARE REGIONAL MEDICAL CENTER HEART INSTITUTE | ||||||||
| City: | POMONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096521000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC0200X | 26NN09058900 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
No ID Information.