Provider Demographics
NPI:1306856612
Name:STRAZZERI, MIA (DO)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:STRAZZERI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2642
Mailing Address - Country:US
Mailing Address - Phone:609-407-7747
Mailing Address - Fax:609-407-7748
Practice Address - Street 1:443 SHORE RD FL 2
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2642
Practice Address - Country:US
Practice Address - Phone:609-407-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB72812207Q00000X
PAOS-009610L173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA260387805OtherTAX ID
NJH06713Medicare UPIN
NJ066776PE1Medicare ID - Type Unspecified