Provider Demographics
NPI:1851468508
Name:BRIZZIO, MARIANO EZEQUIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANO
Middle Name:EZEQUIEL
Last Name:BRIZZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2103 CENROSE CIR
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2427
Mailing Address - Country:US
Mailing Address - Phone:201-664-1146
Mailing Address - Fax:201-447-8658
Practice Address - Street 1:177 FORT WASHINGTON AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-305-4600
Practice Address - Fax:212-305-8304
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME145083208G00000X
NY268336208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08127100OtherLICENSE