Provider Demographics
NPI:1083852958
Name:PETROZZINO, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:PETROZZINO
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 1:646 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3145
Mailing Address - Country:US
Mailing Address - Phone:856-879-2887
Mailing Address - Fax:856-879-2855
Practice Address - Street 1:646 KINGS HWY
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-879-2887
Practice Address - Fax:856-879-2855
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJFP4314477208000000X, 2080N0001X
CAA903722080N0001X
NY2330952080N0001X
NJ25MA094176002080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine