Provider Demographics
NPI:1902845860
Name:DAVID D CARROZZINO DPM, PC
Entity Type:Organization
Organization Name:DAVID D CARROZZINO DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DOMINICK
Authorized Official - Last Name:CARROZZINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-845-5515
Mailing Address - Street 1:158 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5921
Mailing Address - Country:US
Mailing Address - Phone:856-845-5515
Mailing Address - Fax:856-853-6890
Practice Address - Street 1:158 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-5921
Practice Address - Country:US
Practice Address - Phone:856-845-5515
Practice Address - Fax:856-853-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMDO2048213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1687369OtherAMERIHEALTH PPO GROUP NUM
NJ762090OtherBLUE SHIELD GROUP NUMBER
NJ762090Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER