Provider Demographics
NPI:1437109030
Name:MAURIZI, ROMOLO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMOLO
Middle Name:A
Last Name:MAURIZI
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:PO BOX 8117
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07308-8117
Mailing Address - Country:US
Mailing Address - Phone:201-656-5050
Mailing Address - Fax:201-656-0689
Practice Address - Street 1:550 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2707
Practice Address - Country:US
Practice Address - Phone:201-656-5050
Practice Address - Fax:201-656-0689
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA044063002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0710601Medicaid
NJC58863Medicare UPIN
NJ0710601Medicaid