Healthcare Provider Details

I. General information

NPI: 1013049758
Provider Name (Legal Business Name): LAWRENCE JOSEPH ZAZZO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 CLINTON ST
CAMDEN NJ
08103-3529
US

IV. Provider business mailing address

13 OWL CT
MARLTON NJ
08053-2072
US

V. Phone/Fax

Practice location:
  • Phone: 856-968-2320
  • Fax: 856-968-2317
Mailing address:
  • Phone: 609-744-3179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MB027478
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: