MEDICARE: FERMINA M MAZZELLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	25MA08151200	NJ
2	207ZH0000X	Hematology (Pathology) Physician	25MA08151200	NJ

General Provider Information

NPI Number	:	1275522344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERMINA M MAZZELLA MD

Provider Business Mailing Address
First Line	:	185 S ORANGE AVE
Second Line	:	ROOM C-579 - MSB
City	:	NEWARK
State	:	NJ
Zip	:	07103-2757
Country	:	US
Telephone Number	:	973-972-4520
Fax Number	:	973-972-5909

Provider Business Practice Location Address
First Line	:	150 BERGEN ST
Second Line	:	ROOM C-102
City	:	NEWARK
State	:	NJ
Zip	:	07103-2496
Country	:	US
Telephone Number	:	973-972-4619
Fax Number	:	973-972-3199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/11/2025

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