Organization
MAZEN ITANI MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAZEN ITANI MD (OWNER)
(973) 705-7202
Entity
Organization
Contact information
Practice address
183 US HIGHWAY 206 STE 2, FLANDERS, NJ 07836-9261
(973) 705-7202
(973) 705-7262
Mailing address
62 CRESTVIEW RD, MOUNTAIN LAKES, NJ 07046-1224
(973) 705-7202
(973) 705-7262
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
25MA08075500
NJ
208600000X
Surgery Physician
Primary
25MA08075500
NJ
2086S0129X
Vascular Surgery Physician
25MA08075500
NJ
Other
Enumeration date
10/10/2006
Last updated
01/19/2021
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