Provider Demographics
NPI:1013182245
Name:PETROZZINO, CHRISTINE FERANDOS (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:FERANDOS
Last Name:PETROZZINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:FERANDOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:535 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2807
Mailing Address - Country:US
Mailing Address - Phone:856-228-1061
Mailing Address - Fax:856-228-1907
Practice Address - Street 1:535 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2807
Practice Address - Country:US
Practice Address - Phone:856-228-1061
Practice Address - Fax:856-228-1907
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09640300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 102029OtherFL STATE DEPARTMENT OF HEALTH
CAAFE 89730 (RETIRED)OtherMEDICAL BOARD OF CALIFORNIA
BF 9570777OtherUS DOJ, DIVISION OF DEA DIVERSION CONTROL