Provider Demographics
NPI:1174653331
Name:CERVONE, MAURIZIO (DO)
Entity Type:Individual
Prefix:DR
First Name:MAURIZIO
Middle Name:
Last Name:CERVONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:243 OLD BEACH GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1320
Mailing Address - Country:US
Mailing Address - Phone:201-230-9662
Mailing Address - Fax:973-586-6736
Practice Address - Street 1:891 TABOR RD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2733
Practice Address - Country:US
Practice Address - Phone:973-359-8859
Practice Address - Fax:973-359-8860
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB55987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ146517ZCYDMedicare PIN
NJE83109Medicare UPIN