Provider Demographics
NPI:1275502304
Name:AZZOLINI, THOMAS J (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:AZZOLINI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 ADAMS ST STE DE
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2370
Mailing Address - Country:US
Mailing Address - Phone:201-431-7854
Mailing Address - Fax:
Practice Address - Street 1:1320 ADAMS ST STE DE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2370
Practice Address - Country:US
Practice Address - Phone:201-431-7854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004666213E00000X
NJMD001947213ES0103X, 213E00000X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5056900Medicaid
NJP2094195OtherOXFORD
NJ1K9793OtherHEALTHNET
NJ446076OtherCIGNA
NJ1499718OtherGHI
NJ5056900Medicaid
NJ610280QHJMedicare PIN