Provider Demographics
NPI:1477552362
Name:CARROZZINO, DAVID D (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:CARROZZINO
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 1:158 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5921
Mailing Address - Country:US
Mailing Address - Phone:856-845-5515
Mailing Address - Fax:856-853-6890
Practice Address - Street 1:158 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-5921
Practice Address - Country:US
Practice Address - Phone:856-845-5515
Practice Address - Fax:856-853-6890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMDO2048213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0113356000OtherAMERIHEALTH HMO PIN
NJ2360167000OtherAMERIHEALTH HMO GROUP #
NJ4992105Medicaid
NJ0113356000OtherAMERIHEALTH HMO PIN
NJ525775Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ762090Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER