Provider Demographics
NPI:1346131190
Name:FELLOWSHIP MEDICAL GROUP PA
Entity type:Organization
Organization Name:FELLOWSHIP MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAZZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-580-3845
Mailing Address - Street 1:8000 FELLOWSHIP RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3915
Mailing Address - Country:US
Mailing Address - Phone:908-580-3822
Mailing Address - Fax:
Practice Address - Street 1:8000 FELLOWSHIP RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3915
Practice Address - Country:US
Practice Address - Phone:908-580-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty