Provider Demographics
NPI:1841505476
Name:CONZOLO, JOSEPH GERALD
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:GERALD
Last Name:CONZOLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SHERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2346
Mailing Address - Country:US
Mailing Address - Phone:908-591-1829
Mailing Address - Fax:908-722-6859
Practice Address - Street 1:44 SHERBROOK DR
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2346
Practice Address - Country:US
Practice Address - Phone:908-591-1829
Practice Address - Fax:908-722-6859
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R102030400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist