Provider Demographics
NPI:1043072820
Name:MASIELLO, ANTHONY III (NBC-HWC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MASIELLO
Suffix:III
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E MAIN STREET #5003
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809
Mailing Address - Country:US
Mailing Address - Phone:908-623-0218
Mailing Address - Fax:
Practice Address - Street 1:24 E MAIN STREET #5003
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809
Practice Address - Country:US
Practice Address - Phone:908-623-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA-3065672171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach