Provider Demographics
NPI:1952325334
Name:MARZILI, THOMAS JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:MARZILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ROUTE 70
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2371
Mailing Address - Country:US
Mailing Address - Phone:609-451-2020
Mailing Address - Fax:609-451-2021
Practice Address - Street 1:128 ROUTE 70
Practice Address - Street 2:SUITE 13
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2371
Practice Address - Country:US
Practice Address - Phone:609-451-2020
Practice Address - Fax:609-451-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56370207Q00000X
NJ25MA05637000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5520304Medicaid
F51851Medicare UPIN
NJ5520304Medicaid