MS. MARISSA ANNE FANELLI (NPI# 1750650859) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750650859 |
| Entity Type | Individual |
| Full Name | MS. MARISSA ANNE FANELLI |
| Credential | RDH |
| Practice Address |
741 Broadway Newark NJ 07104-4309 |
| Mailing Address |
430 Edgewood Pl Rutherford NJ 07070-2662 |
| Practice Telephone | 9734831300 |
| Practice Fax Number | 9734833787 |
| Mailing Telephone | 2015628844 |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2011-12-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | 22HI00901200 | NJ | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | RDH LICENSE NUMBER | 22HI00901200 | 01 |
| Street Address |
741 BROADWAY |
| City | NEWARK |
| State | NJ |
| Zip Code | 07104-4309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871580647 | Alan Y Tso | Internal Medicine | 741 Broadway, Newark, NJ 07104-4309 | 2005-10-05 |
| 1538772165 | Monica Yvette Johnson | Nurse Practitioner | 741 Broadway, Newark, NJ 07104-4309 | 2020-08-24 |
| 1518576206 | Akuwa D Gbogbotsi | Registered Nurse | 741 Broadway, Newark, NJ 07104-4309 | 2020-07-28 |
| 1487123386 | Srujana Kraleti | Dentist | 741 Broadway, Newark, NJ 07104-4309 | 2018-11-20 |
| 1942726369 | Beyyinah Hasan | Nurse Practitioner | 741 Broadway, Newark, NJ 07104-4309 | 2017-08-17 |
| 1902346810 | Hearns Paul | Social Worker | 741 Broadway, Newark, NJ 07104-4309 | 2017-02-27 |
| 1952843849 | Alexandra Noel | Nurse Practitioner | 741 Broadway, Newark, NJ 07104-4309 | 2016-11-09 |
| 1619427093 | Nadia Gabaud | Nurse Practitioner | 741 Broadway, Newark, NJ 07104-4309 | 2016-10-10 |
| 1043669245 | Jorane Bonheur | Nurse Practitioner | 741 Broadway, Newark, NJ 07104-4309 | 2016-06-08 |
| 1700262474 | Raksha Poojary | Dentist | 741 Broadway, Newark, NJ 07104-4309 | 2015-08-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538790563 | North Ward Medical Arts LLC | Internal Medicine | 485-491 Mt Prospect Ave, Newark, NJ 07104 | 2020-01-29 |
| 1386149011 | Community Options Enterprises, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 504-506 Mount Prospect Ave, Newark, NJ 07104 | 2018-03-26 |
| 1710406293 | Bmrr Corporation | Durable Medical Equipment & Medical Supplies | 664 Mt Prospect Ave, Newark, NJ 07104 | 2017-09-15 |
| 1508390287 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 387 Ridge Street, Newark, NJ 07104 | 2017-04-19 |
| 1104280890 | North Essex Pediatrics Inc | Clinic/Center | 644 Mt Prospect Ave, Suite1, Newak, NJ 07104 | 2016-04-08 |
| 1306257076 | Sonia Martinez | Technician/Technologist | 677 Mount Prospect Avenue, Newark, NJ 07104 | 2014-05-15 |
| 1891022612 | Sofia Berkovich | Internal Medicine | 717-727 Broadway, Newark, NJ 07104 | 2009-11-16 |
| 1538302138 | Bellazmin Natalie Taylor | Physician Assistant | 354 Doremus Avenue, Newark, NJ 07104 | 2009-04-13 |
| 1740483502 | Clear Vision Optical, Inc. | Eyewear Supplier (Equipment, not the service) | 677 Mt Prospect Avenue, Newark, NJ 07104 | 2007-06-08 |
| 1083815146 | Rafael A Hernandez | Pharmacist | 794 Mt. Prospect Ave., Newark, NJ 07104 | 2007-05-29 |
| Find all providers in zip 07104 | ||||
| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023561602 | Kohli Dental Corp | Dental Hygienist | 5910 Thornton Ave Ste D, Newark, CA 94560-3800 | 2016-07-29 |
| 1578915534 | Nancy Brohawn | Dental Hygienist | 39 Country Hills Dr, Newark, DE 19711-2517 | 2016-07-01 |
| 1548663040 | Janice Large | Dental Hygienist | 675 Price Rd, Newark, OH 43055-9506 | 2014-09-29 |
| 1942628474 | Candace Niccolson | Dental Hygienist | 6546 Flanders Dr, Newark, CA 94560-1163 | 2014-04-01 |
| 1922526227 | Helen Mengstu | Dental Hygienist | 675 Price Rd, Newark, OH 43055-9506 | 2017-09-07 |
| 1518407873 | Kayla Guido | Dental Hygienist | 110 William St, Newark, NJ 07102-1304 | 2017-03-06 |
| 1801212725 | Christine Gomes | Dental Hygienist | 22 Downing St, Newark, NJ 07105-2314 | 2014-03-16 |
| 1730226242 | Luz M Moreno | Dental Hygienist | 239 Elm St, Newark, NJ 07105-1720 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952927642 | Kathleen Patricia Visocki | Dental Hygienist | 420 Sylvan Pl, Haworth, NJ 07641-1730 | 2020-06-18 |
| 1063032381 | Lisbeth Jimenez | Dental Hygienist | 832 Salem Rd, Union, NJ 07083-7571 | 2020-04-17 |
| 1902395403 | Karese Laguerre | Dental Hygienist | 44 Pinetree Dr, Parlin, NJ 08859-1151 | 2018-05-09 |
| 1528562188 | Jessica Lorenzo | Dental Hygienist | 123 Nj-33 #104, Manalapan Township, NJ 07726 | 2018-03-20 |
| 1356840672 | Ferda Demirtas | Dental Hygienist | 240 Half Mile Rd Ste 1, Red Bank, NJ 07701-5684 | 2018-02-02 |
| 1902350580 | Jessica Gelber | Dental Hygienist | 16-20 W Ivy Ln, Englewood, NJ 07631-6712 | 2016-08-11 |
| 1306390299 | Lisa Chascsa | Dental Hygienist | 519 Arch St, Delran, NJ 08075-1111 | 2016-08-08 |
| 1730560996 | Richard Schmidt | Dental Hygienist | 170 Morris Tpke, Randolph, NJ 07869-2805 | 2015-06-14 |
| 1750649604 | Rechal M Patel | Dental Hygienist | 200 Monroe Ave, Edison, NJ 08820-3720 | 2012-04-29 |
| 1730340266 | Rosita D Dotson | Dental Hygienist | 4 Willowdale Ct, Montclair, NJ 07042-4427 | 2008-06-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.