Mazen Itani MD PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

25MA08075500 Issued in NJ

Legal business name

MAZEN ITANI MD PC

Practice address

183 US Highway 206 Ste 2
Flanders, NJ 07836-9261

Phone

(973) 705-7202

Fax

(973) 705-7262

NPI assigned

Oct 10, 2006

Last updated

Jan 19, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mazen Itani, MDNPI 1770555930

Title

Owner

Phone

(973) 705-7202

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mazen S. Itani, M.D.

  • Surgery Physician
  • Flanders, NJ
  • NPI 1770555930

  Vascular & Interventional Radiology

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1821186586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 CRESTVIEW RD",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461224",
            "telephone_number": "973-705-7202",
            "fax_number": "973-705-7262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 US HIGHWAY 206 STE 2",
            "city": "FLANDERS",
            "state": "NJ",
            "postal_code": "078369261",
            "telephone_number": "973-705-7202",
            "fax_number": "973-705-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAZEN ITANI MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A",
        "authorized_official_last_name": "ITANI",
        "authorized_official_first_name": "MAZEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-705-7202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NJ",
            "license": "25MA08075500",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA08075500",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "25MA08075500",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Leah Mandell, MS, RD
• Peter Marsicano IV, PT, DPT
• Nancy M Martin, LCSW
• Davi Martins
• Melissa Rose Martirano, DMD
• Hope A McDonald, MSW, LCSW
• Elizabeth McDougal, RN
• Medical Associates of Mt Olive Inc
• Katelyn Meier, LCSW
• Alex M Mercado, M.D.

• Surgery Physician in Flanders, NJ
• Providers in Flanders, NJ by specialty
• Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.