MEDICARE: DR. DOMINIC F MAZZOCCHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA04770300	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	110172484	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0065873	OTHER	NJ	GHI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	223360408-006	OTHER	NJ	QUALCARE
4	P414149	OTHER	NJ	OXFORD
6	1K1007	OTHER	NJ	HEALTHNET

General Provider Information

NPI Number	:	1679546501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC F MAZZOCCHI M.D.

Provider Business Mailing Address
First Line	:	702 CARNATION AVENUE
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724
Country	:	US
Telephone Number	:	732-840-2378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 BEAVER DAM RD
Second Line	:
City	:	POINT PLEASANT BEACH
State	:	NJ
Zip	:	08742-4970
Country	:	US
Telephone Number	:	732-295-0808
Fax Number	:	732-295-3845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. DOMINIC F MAZZOCCHI M.D.” Practice Location

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