Provider Demographics
NPI:1750364469
Name:DEMARZO, EUGENE (DPM)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:DEMARZO
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 1:570 RAHWAY AVE
Mailing Address - Street 2:PO BOX 1102
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3485
Mailing Address - Country:US
Mailing Address - Phone:732-750-2424
Mailing Address - Fax:732-750-2500
Practice Address - Street 1:570 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3485
Practice Address - Country:US
Practice Address - Phone:732-750-2424
Practice Address - Fax:732-750-2500
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01835213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ201420301Medicaid
NJ201420301Medicaid
556067Medicare ID - Type Unspecified
5499550001Medicare NSC