Healthcare Provider Details

I. General information

NPI: 1275522344
Provider Name (Legal Business Name): FERMINA M MAZZELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST ROOM C-102
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

185 S ORANGE AVE ROOM C-579 - MSB
NEWARK NJ
07103-2757
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4619
  • Fax: 973-972-3199
Mailing address:
  • Phone: 973-972-4520
  • Fax: 973-972-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number25MA08151200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA08151200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: