Provider Demographics
NPI:1790399228
Name:VENEZIO, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:VENEZIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1090
Mailing Address - Country:US
Mailing Address - Phone:732-425-0104
Mailing Address - Fax:
Practice Address - Street 1:2080 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1090
Practice Address - Country:US
Practice Address - Phone:732-671-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer