Provider Demographics
NPI:1003649849
Name:PEZZINO, ALEX (MSN, FNP)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:PEZZINO
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 ADDISON PL
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4540
Mailing Address - Country:US
Mailing Address - Phone:973-653-6398
Mailing Address - Fax:
Practice Address - Street 1:111 MADISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6083
Practice Address - Country:US
Practice Address - Phone:862-242-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15114500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily