Provider Demographics
NPI:1386646768
Name:AZZARITI, GEORGE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:AZZARITI
Suffix:
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 1:18 RAILROAD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4105
Mailing Address - Country:US
Mailing Address - Phone:201-291-2323
Mailing Address - Fax:201-291-2328
Practice Address - Street 1:18 RAILROAD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4105
Practice Address - Country:US
Practice Address - Phone:201-928-0748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02002700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1592602Medicaid
NJ1592602Medicare ID - Type Unspecified