Provider Demographics
NPI:1255485124
Name:DOMINIC MAZZOCCHI MD LLC
Entity Type:Organization
Organization Name:DOMINIC MAZZOCCHI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAZZOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-295-0808
Mailing Address - Street 1:1401 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4970
Mailing Address - Country:US
Mailing Address - Phone:732-295-0808
Mailing Address - Fax:732-295-3845
Practice Address - Street 1:1401 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742-4970
Practice Address - Country:US
Practice Address - Phone:732-295-0808
Practice Address - Fax:732-295-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty