Healthcare Provider Details

I. General information

NPI: 1699747121
Provider Name (Legal Business Name): JOSEPH PHILIP MAZZARELLI JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5439 ROUTE 38
PENNSAUKEN NJ
08109-4809
US

IV. Provider business mailing address

5439 ROUTE 38
PENNSAUKEN NJ
08109-4809
US

V. Phone/Fax

Practice location:
  • Phone: 856-662-6745
  • Fax: 856-662-3730
Mailing address:
  • Phone: 856-662-6745
  • Fax: 856-662-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1421
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: