Provider Demographics
NPI:1699889535
Name:COZZARELLI, JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:COZZARELLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 N SPRING GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1529
Mailing Address - Country:US
Mailing Address - Phone:973-667-7096
Mailing Address - Fax:
Practice Address - Street 1:155 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2407
Practice Address - Country:US
Practice Address - Phone:973-450-0878
Practice Address - Fax:973-450-1013
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00188800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5230403Medicaid
NJU29368Medicare UPIN
NJ5230403Medicaid