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General NPI Number Information
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NPI Number | 1255485124
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Entity Type | Organization
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Legal Business Name | DOMINIC MAZZOCCHI MD LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 1401 BEAVER DAM RD
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City | POINT PLEASANT
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State | NJ
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Zip | 08742-4970
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Country | US
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Telephone | 732-295-0808
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Fax | 732-295-3845
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Provider Business Mailing Address
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Address Line | 1401 BEAVER DAM RD
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City | POINT PLEASANT
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State | NJ
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Zip | 08742-4970
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Country | US
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Telephone | 732-295-0808
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Fax | 732-295-3845
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Authorized Official
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Title or Position | MD OWNER
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Name | DR. DOMINIC F MAZZOCCHI
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Credential | MD
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Telephone | 732-295-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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