Provider Demographics
NPI:1831163237
Name:MAZZUCA, ROBERT F (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:MAZZUCA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FIFTH ST
Mailing Address - Street 2:STE A
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004
Mailing Address - Country:US
Mailing Address - Phone:856-768-2758
Mailing Address - Fax:856-768-8364
Practice Address - Street 1:501 FIFTH ST
Practice Address - Street 2:STE A
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004
Practice Address - Country:US
Practice Address - Phone:856-768-2758
Practice Address - Fax:856-768-8364
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB39135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0090878001OtherAMERIHEALTH
NJ1909401Medicaid
J1887OtherHORIZON
013463OtherAETNA
C52769Medicare UPIN
NJ1909401Medicaid