Provider Demographics
NPI:1033139407
Name:MAZZARELLI, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:MAZZARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST
Mailing Address - Street 2:SUITE SW200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-382-6530
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER UNIVERSITY EMERGENCY PHYSICIANS
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2351
Practice Address - Fax:856-968-8272
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA079708207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01077790500OtherAMERICHOICE
NJ3994254OtherCIGNA
NJ1319274OtherAETNA
NJP3701453OtherOXFORD
NJ2703048OtherUNITED HEALTHCARE
NJ2799050000OtherAMERIHEALTH/KEYSTONE/IBC
NJ60025867OtherHORIZON NJ HEALTH
NJ0110752Medicaid
NJP00375246Medicare PIN
NJ2799050000OtherAMERIHEALTH/KEYSTONE/IBC