Healthcare Provider Details

I. General information

NPI: 1679503254
Provider Name (Legal Business Name): PATRICK W. MARZANO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST CASE MANAGEMENT
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

245 WOOLLEY AVE
STATEN ISLAND NY
10314-2003
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5330
  • Fax:
Mailing address:
  • Phone: 718-273-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: