Provider Demographics
NPI:1194810259
Name:CANNAROZZI, NICHOLAS ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:CANNAROZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-630-8950
Practice Address - Fax:973-669-9749
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02173000207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA02173000OtherNJ STATE MEDICAL LICENSE
NJD02655800OtherNJ STATE NARCOTIC NUMBER
NJAC2620448OtherFEDERAL NARCOTIC LICENSE
NJ1987607Medicaid
NJC60450Medicare UPIN
NJD02655800OtherNJ STATE NARCOTIC NUMBER