Provider Demographics
NPI:1639418981
Name:NICHOLAS A. CANNAROZZI, M.D., P.A.
Entity Type:Organization
Organization Name:NICHOLAS A. CANNAROZZI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANNAROZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-783-6000
Mailing Address - Street 1:127 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4855
Mailing Address - Country:US
Mailing Address - Phone:973-783-6000
Mailing Address - Fax:973-783-0020
Practice Address - Street 1:127 PINE ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4855
Practice Address - Country:US
Practice Address - Phone:973-783-6000
Practice Address - Fax:973-783-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty