Healthcare Provider Details

I. General information

NPI: 1114025145
Provider Name (Legal Business Name): BELZO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 US HIGHWAY 46
KENVIL NJ
07847-2643
US

IV. Provider business mailing address

25 W MAIN ST
ROCKAWAY NJ
07866-3435
US

V. Phone/Fax

Practice location:
  • Phone: 973-625-0083
  • Fax: 973-625-5095
Mailing address:
  • Phone: 973-625-8558
  • Fax: 973-625-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00477700
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier2148225
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: GREG DEPAOLO
Title or Position: OWNER
Credential:
Phone: 973-625-8558