Organization
PREMIER FAMILY MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VITO MAZZOCCOLI M.D (MEDICAL DIRECTOR)
(973) 403-3200
Entity
Organization
Contact information
Practice address
110 BLOOMFIELD AVE, CALDWELL, NJ 07006-5336
(973) 403-3200
(973) 403-3250
Mailing address
110 BLOOMFIELD AVE, CALDWELL, NJ 07006-5336
(973) 403-3200
(973) 403-3250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA072343
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029483
—
NJ
Enumeration date
05/23/2006
Last updated
08/22/2020
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