Provider Demographics
NPI:1053425900
Name:PODIATRY ASSOCIATES OF BELLEVILLE PC
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES OF BELLEVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COZZARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-450-0878
Mailing Address - Street 1:155 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2407
Mailing Address - Country:US
Mailing Address - Phone:973-450-0878
Mailing Address - Fax:973-450-1013
Practice Address - Street 1:155 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2407
Practice Address - Country:US
Practice Address - Phone:973-450-0878
Practice Address - Fax:973-450-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00188800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5230306Medicaid
NJ5230306Medicaid
NJ1256240001Medicare NSC