Marissa Anne Fanelli, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

22HI00901200 Issued in NJ

Practice address

741 Broadway
Newark, NJ 07104-4309

Phone

(973) 483-1300

Fax

(973) 483-3787

NPI assigned

Dec 19, 2011

Last updated

Dec 19, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324252800000",
    "number": "1750650859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 EDGEWOOD PL",
            "city": "RUTHERFORD",
            "state": "NJ",
            "postal_code": "070702662",
            "telephone_number": "201-562-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 BROADWAY",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071044309",
            "telephone_number": "973-483-1300",
            "fax_number": "973-483-3787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANELLI",
        "first_name": "MARISSA",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-19",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NJ",
            "license": "22HI00901200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RDH LICENSE NUMBER",
            "identifier": "22HI00901200",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family Service Bureau of Newark
• Family Service Bureau of Newark
• Family Tree Wellness
• Family Vipcare Incorporated
• Shou-Yuan Fan, L.AC.
• Chakia Faniel
• Adam N Fano
• Sara Farajian
• Samah Farid, DPM
• Atif Farooqi

• Dental Hygienist in Newark, NJ
• Providers in Newark, NJ by specialty
• Dental Hygienist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.