Basic Information
| Provider Information | |||||||||
| NPI: | 1346333879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARESCA | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1967 HIGHWAY 34 STE 102 | ||||||||
| Address2: | |||||||||
| City: | WALL TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077199738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323451180 | ||||||||
| FaxNumber: | 7325304476 | ||||||||
| Practice Location | |||||||||
| Address1: | 1967 STATE ROUTE 34 STE 102 | ||||||||
| Address2: | |||||||||
| City: | WALL TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323451180 | ||||||||
| FaxNumber: | 7325304476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 25MP00077600 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.