=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982782124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE CAROL COMIZIO MD, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 07/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MADISON AVE STE 200
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-7305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-775-9248
-----------------------------------------------------
Fax | 877-787-9098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 122
-----------------------------------------------------
City | NEW VERNON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07976-0122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-775-9248
-----------------------------------------------------
Fax | 877-787-9098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 13578
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 25MA08713200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------