Healthcare Provider Details

I. General information

NPI: 1174523468
Provider Name (Legal Business Name): MARTIN S. GIZZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ESSEX ST STE 303
HACKENSACK NJ
07601-8566
US

IV. Provider business mailing address

360 ESSEX ST STE 303
HACKENSACK NJ
07601-8566
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-8100
  • Fax:
Mailing address:
  • Phone: 551-996-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA58400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5600600
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: