Healthcare Provider Details

I. General information

NPI: 1962430371
Provider Name (Legal Business Name): PETER L CARRAZZONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 GOFFLE RD STE 104
HAWTHORNE NJ
07506-2014
US

IV. Provider business mailing address

271 GROVE AVE STE E
VERONA NJ
07044-1730
US

V. Phone/Fax

Practice location:
  • Phone: 973-636-9000
  • Fax: 833-493-1245
Mailing address:
  • Phone: 973-559-3700
  • Fax: 833-484-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA04591200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: