Provider Demographics
NPI:1679546501
Name:MAZZOCCHI, DOMINIC F (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:F
Last Name:MAZZOCCHI
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 1:702 CARNATION AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-840-2378
Mailing Address - Fax:
Practice Address - Street 1:1401 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-4970
Practice Address - Country:US
Practice Address - Phone:732-295-0808
Practice Address - Fax:732-295-3845
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04770300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0065873OtherGHI
NJ0942006Medicaid
NJ223360408-006OtherQUALCARE
NJP414149OtherOXFORD
NJ110172484OtherRAILROAD MEDICARE
NJ1K1007OtherHEALTHNET
NJ0942006Medicaid