Provider Demographics
NPI:1952505398
Name:PIZZURRO, MARK M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:PIZZURRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:85 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4561
Mailing Address - Country:US
Mailing Address - Phone:201-445-2830
Mailing Address - Fax:201-445-7471
Practice Address - Street 1:85 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4561
Practice Address - Country:US
Practice Address - Phone:201-445-2830
Practice Address - Fax:201-445-7471
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08235300207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1610397OtherAETNA HMO
NJ7567913OtherAETNA PPO
NJ115220WX5Medicare PIN
NJ7567913OtherAETNA PPO