Healthcare Provider Details

I. General information

NPI: 1306856612
Provider Name (Legal Business Name): MIA STRAZZERI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 SHORE RD FL 2
SOMERS POINT NJ
08244-2642
US

IV. Provider business mailing address

443 SHORE RD
SOMERS POINT NJ
08244-2642
US

V. Phone/Fax

Practice location:
  • Phone: 609-407-7747
  • Fax:
Mailing address:
  • Phone: 609-407-7747
  • Fax: 609-407-7748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberOS-009610L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB72812
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: