Premier Family Medical, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MA072343 Issued in NJ

Legal business name

PREMIER FAMILY MEDICAL, PC

Practice address

110 Bloomfield Ave
Caldwell, NJ 07006-5336

Phone

(973) 403-3200

Fax

(973) 403-3250

NPI assigned

May 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Vito Mazzoccoli, M.DNPI 1518936053

Title

Medical Director

Phone

(973) 403-3200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vito Mazzoccoli, M.D.

  • Family Medicine Physician
  • Caldwell, NJ
  • NPI 1518936053
  Medicare reassignment NPD Authorized official
• Boris G Chusid, M.D.

  • Gastroenterology Physician
  • Franklin Lakes, NJ
  • NPI 1518967769
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891740643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BLOOMFIELD AVE",
            "city": "CALDWELL",
            "state": "NJ",
            "postal_code": "070065336",
            "telephone_number": "973-403-3200",
            "fax_number": "973-403-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BLOOMFIELD AVE",
            "city": "CALDWELL",
            "state": "NJ",
            "postal_code": "070065336",
            "telephone_number": "973-403-3200",
            "fax_number": "973-403-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAZZOCCOLI",
        "authorized_official_first_name": "VITO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "973-403-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MA072343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0029483",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Perry, PMHNP-BC, CNM
• Melissa Petrone, LCSW
• Salvatrice Rosalia Polizzotto, MSW, LCSW LLC
• Wendy R Pollack, LCSW
• Precision Vision
• Cynthia R Prestigiacomo, MD
• Prime Arthritis and Rheumatology Center LLC
• Princeton Behavioral Associates, LLC
• Professional Occupational & Physical Therapy, PLLC
• Professional Orthopedic and Sports Physical Therapy of NJ, LLC

• Family Medicine Physician in Caldwell, NJ
• Providers in Caldwell, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.