Healthcare Provider Details

I. General information

NPI: 1336147594
Provider Name (Legal Business Name): CARMEN JOHN OCCHIUZZI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 BELMONT AVE SUITE 3
NORTH HALEDON NJ
07508-2574
US

IV. Provider business mailing address

909 BELMONT AVE SUITE 3
NORTH HALEDON NJ
07508-2574
US

V. Phone/Fax

Practice location:
  • Phone: 973-423-3223
  • Fax: 973-423-2199
Mailing address:
  • Phone: 973-423-3223
  • Fax: 973-423-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00155500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: