Healthcare Provider Details

I. General information

NPI: 1386646768
Provider Name (Legal Business Name): GEORGE MICHAEL AZZARITI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 RAILROAD AVE SUITE 103
ROCHELLE PARK NJ
07662-4105
US

IV. Provider business mailing address

18 RAILROAD AVE SUITE 103
ROCHELLE PARK NJ
07662-4105
US

V. Phone/Fax

Practice location:
  • Phone: 201-928-0748
  • Fax:
Mailing address:
  • Phone: 201-291-2323
  • Fax: 201-291-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA02002700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: