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General NPI Number Information
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NPI Number | 1689754731
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Entity Type | Organization
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Legal Business Name | ALEXANDER MAZZIOTTI, M.D., P.A.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 268 LINCOLN AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-1201
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Country | US
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Telephone | 973-423-3335
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Fax |
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Provider Business Mailing Address
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Address Line | 268 LINCOLN AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-1201
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Country | US
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Telephone | 973-423-3335
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDER R. MAZZIOTTI
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Credential | M.D.
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Telephone | 973-423-3335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 36284
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License Number State | NJ
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