Provider Demographics
NPI:1306928791
Name:PIZZELANTI, DONNA M (DO)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:PIZZELANTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1765
Mailing Address - Country:US
Mailing Address - Phone:732-560-0490
Mailing Address - Fax:732-560-9681
Practice Address - Street 1:101 E UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1765
Practice Address - Country:US
Practice Address - Phone:732-560-0490
Practice Address - Fax:732-560-9681
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB64188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G81822Medicare UPIN
018075BY3Medicare ID - Type Unspecified