Provider Demographics
NPI:1881621407
Name:PIZZANO, RICHARD GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GABRIEL
Last Name:PIZZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BLOOMFIELD AVENUE
Mailing Address - Street 2:SUITE K
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-429-2876
Mailing Address - Fax:973-748-0773
Practice Address - Street 1:135 BLOOMFIELD AVENUE
Practice Address - Street 2:SUITE K
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-429-2876
Practice Address - Fax:973-748-0773
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02400200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3051307Medicaid
NJ055324Medicare ID - Type Unspecified
NJ3051307Medicaid