=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316105711
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE C AZU MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2008
-----------------------------------------------------
Last Update Date | 05/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 97 W PARKWAY
-----------------------------------------------------
City | POMPTON PLAINS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07444-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-831-5056
-----------------------------------------------------
Fax | 973-907-1084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 416457
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02241-6457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-656-6280
-----------------------------------------------------
Fax | 973-290-7495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 245487
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086X0206X
-----------------------------------------------------
Taxonomy Name | Surgical Oncology Physician
-----------------------------------------------------
License Number | 25MA08641600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------