Provider Demographics
NPI:1366481624
Name:PETROZZINO, VITO A X (MD)
Entity Type:Individual
Prefix:
First Name:VITO
Middle Name:A
Last Name:PETROZZINO
Suffix:X
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 E NORTHFIELD RD
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-992-3666
Mailing Address - Fax:973-992-2837
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:SUITE LL2
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-992-3666
Practice Address - Fax:973-992-2837
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04265900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55050Medicare UPIN