Provider Demographics
NPI:1063485092
Name:BAZSA, MARIA L (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:BAZSA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 HIGH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9604
Mailing Address - Country:US
Mailing Address - Phone:973-579-2100
Mailing Address - Fax:973-579-6638
Practice Address - Street 1:222 HIGH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9604
Practice Address - Country:US
Practice Address - Phone:973-579-2100
Practice Address - Fax:973-579-6638
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00020700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0022861Medicaid
Q02020Medicare UPIN
NJ0022861Medicaid