Provider Demographics
NPI:1184622748
Name:MOSOLINO, JOHN A (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MOSOLINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 ABBOTT BLVD
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4151
Mailing Address - Country:US
Mailing Address - Phone:201-224-0255
Mailing Address - Fax:201-224-0395
Practice Address - Street 1:810 ABBOTT BLVD
Practice Address - Street 2:SUITE G-1
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4151
Practice Address - Country:US
Practice Address - Phone:201-224-0255
Practice Address - Fax:201-224-0395
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00122300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ196660Medicaid
NJ455505Medicare PIN
NJ480001203Medicare PIN
NJT45470Medicare UPIN