Provider Demographics
NPI:1942255831
Name:MAZZUCA EYE AND LASER CENTERS,PA
Entity Type:Organization
Organization Name:MAZZUCA EYE AND LASER CENTERS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARANDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-678-4800
Mailing Address - Street 1:48 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1754
Mailing Address - Country:US
Mailing Address - Phone:856-678-4800
Mailing Address - Fax:
Practice Address - Street 1:48 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1754
Practice Address - Country:US
Practice Address - Phone:856-678-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2175328000OtherAMERIHEALTH PPO
NJ5144456OtherAETNA
NJCE7177OtherPALMETTO GBA
NJ2272222000OtherAMERIHEALTH HMO
NJ=========OtherTAX ID
NJ=========OtherBLUE CROSS
NJCE7177OtherPALMETTO GBA
NJ2175328000OtherAMERIHEALTH PPO
NJ=========OtherTAX ID