Basic Information
| Provider Information | |||||||||
| NPI: | 1639746423 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACELLI | ||||||||
| FirstName: | SYDNEY | ||||||||
| MiddleName: | BLAIR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 271 GROVE AVE STE A | ||||||||
| Address2: | |||||||||
| City: | VERONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070441731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732392600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 HIGHLAND AVE STE 100B | ||||||||
| Address2: | |||||||||
| City: | GLEN RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070281521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3800973969 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2021 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.