Healthcare Provider Details

I. General information

NPI: 1104977453
Provider Name (Legal Business Name): ROY M NUZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE SUITE 750
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

99 BEAUVOIR AVE SUITE 750
SUMMIT NJ
07901-3533
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5531
  • Fax: 908-522-5519
Mailing address:
  • Phone: 908-522-5531
  • Fax: 908-522-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMA33985
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: