Individual
DR. DOUGLAS EDWARD MAZZUCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
48 N BROADWAY, PENNSVILLE, NJ 08070-1754
(856) 678-4800
(856) 678-3630
Mailing address
48 N BROADWAY, PENNSVILLE, NJ 08070-1754
(856) 678-4800
(856) 678-3630
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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