Individual
DR. DOUGLAS EDWARD MAZZUCA
Active
Individual
DR. DOUGLAS EDWARD MAZZUCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25MB04899600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105577000
AMERIHEALTH
NJ
01
—
180030900
PALMETTO GBA
NJ
01
—
223485583
TAX ID
NJ
01
—
342
OPERATING ENGINEERS 825
NJ
01
—
55179
AETNA
NJ
01
—
SA000004901
AMERICHOICE
NJ
Enumeration date
10/24/2005
Last updated
09/22/2020
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