Provider Demographics
NPI:1689754731
Name:ALEXANDER MAZZIOTTI, M.D., P.A.
Entity Type:Organization
Organization Name:ALEXANDER MAZZIOTTI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAZZIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-423-3335
Mailing Address - Street 1:268 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1201
Mailing Address - Country:US
Mailing Address - Phone:973-423-3335
Mailing Address - Fax:
Practice Address - Street 1:268 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1201
Practice Address - Country:US
Practice Address - Phone:973-423-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ36284261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461049Medicare ID - Type UnspecifiedMEDICARE NUMBER
NJC56257Medicare UPIN