Provider Demographics
NPI:1962430371
Name:CARRAZZONE, PETER L (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:CARRAZZONE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 GROVE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-559-3700
Mailing Address - Fax:833-484-1686
Practice Address - Street 1:1114 GOFFLE RD STE 104
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2014
Practice Address - Country:US
Practice Address - Phone:973-636-9000
Practice Address - Fax:833-493-1245
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04591200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080121207OtherRAILROAD MEDICARE
NJ456998BBCMedicare ID - Type Unspecified
NJ080121207OtherRAILROAD MEDICARE
NJ080121207OtherRAILROAD MEDICARE