Provider Demographics
NPI:1043384316
Name:COCOZIELLO, ALEXANDER R (DO)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:R
Last Name:COCOZIELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MARKET ST 2B
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5996
Mailing Address - Country:US
Mailing Address - Phone:201-794-8773
Mailing Address - Fax:201-794-0335
Practice Address - Street 1:444 MARKET ST 2B
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5996
Practice Address - Country:US
Practice Address - Phone:201-794-8773
Practice Address - Fax:201-794-0335
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB24994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1948105Medicaid
NJ160334OtherMEDICARE - TYPE SPECIFIED
NJ160334OtherMEDICARE - TYPE SPECIFIED
NJ1948105Medicaid