Provider Demographics
NPI:1669631719
Name:MOZULAY, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MOZULAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:105 BEECH TREE CT
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9677
Mailing Address - Country:US
Mailing Address - Phone:856-223-9372
Mailing Address - Fax:856-223-9380
Practice Address - Street 1:1817 S 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1945
Practice Address - Country:US
Practice Address - Phone:856-223-9372
Practice Address - Fax:856-223-9380
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2013-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD046617L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF42041Medicare UPIN