MEDICARE: DR. MICHAEL VICTOR VENANZI 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	207V00000X	Obstetrics & Gynecology Physician	25MA03937700	NJ

General Provider Information

NPI Number	:	1417038373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL VICTOR VENANZI MD

Provider Business Mailing Address
First Line	:	539 OPENAKI RD
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-3318
Country	:	US
Telephone Number	:	973-361-1149
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 ROUTE 10
Second Line	:	SUITE 1
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2141
Country	:	US
Telephone Number	:	973-328-1262
Fax Number	:	973-328-8576

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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