Provider Demographics
NPI:1194915512
Name:LACORAZZA, JOHN W (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:LACORAZZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 PRINCETON PIKE, BLDG. 5
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-815-7829
Mailing Address - Fax:609-815-7894
Practice Address - Street 1:750 BRUNSWICK AVE
Practice Address - Street 2:CAPITAL HEALTH HOSPITALIST GROUP, 1ST FLOOR
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4143
Practice Address - Country:US
Practice Address - Phone:609-815-7887
Practice Address - Fax:609-394-6299
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015250207Q00000X
NJ25MB08772000207Q00000X, 207RH0005X
NY264845-1207Q00000X
CT50927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024948890001Medicaid
NJ0302163Medicaid
PA189864Medicare PIN