Healthcare Provider Details

I. General information

NPI: 1003649849
Provider Name (Legal Business Name): ALEX PEZZINO MSN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MADISON AVE STE 100
MORRISTOWN NJ
07960-6083
US

IV. Provider business mailing address

261 ADDISON PL
PARAMUS NJ
07652-4540
US

V. Phone/Fax

Practice location:
  • Phone: 862-242-1922
  • Fax:
Mailing address:
  • Phone: 973-653-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15114500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: