MEDICARE: DR. PETER L CARRAZZONE M.D.

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	207Q00000X	Family Medicine Physician	25MA04591200	NJ

General Provider Information

NPI Number	:	1962430371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER L CARRAZZONE M.D.

Provider Business Mailing Address
First Line	:	271 GROVE AVE STE E
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-1730
Country	:	US
Telephone Number	:	973-559-3700
Fax Number	:	833-484-1686

Provider Business Practice Location Address
First Line	:	1114 GOFFLE RD STE 104
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-2014
Country	:	US
Telephone Number	:	973-636-9000
Fax Number	:	833-493-1245

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	04/16/2025

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