Provider Demographics
NPI:1376643973
Name:GAZZILLO, FRANK LOUIS JR (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:LOUIS
Last Name:GAZZILLO
Suffix:JR
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 1:220 HAMBURG TPKE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2110
Mailing Address - Country:US
Mailing Address - Phone:973-942-4778
Mailing Address - Fax:973-942-7020
Practice Address - Street 1:220 HAMBURG TPKE
Practice Address - Street 2:SUITE 16
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2110
Practice Address - Country:US
Practice Address - Phone:973-942-4778
Practice Address - Fax:973-942-7020
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0274332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1322800Medicaid
NJ1322800Medicaid
NJ118939BLJMedicare ID - Type Unspecified