Provider Demographics
NPI:1093562720
Name:MAZALTOV LLC
Entity type:Organization
Organization Name:MAZALTOV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:YORISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-806-9048
Mailing Address - Street 1:10 FAIRWAY DR.
Mailing Address - Street 2:SUITE 100, ROOM 209
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1812
Mailing Address - Country:US
Mailing Address - Phone:954-578-3167
Mailing Address - Fax:954-578-3168
Practice Address - Street 1:10 FAIRWAY DR.
Practice Address - Street 2:SUITE 100, ROOM 209
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1812
Practice Address - Country:US
Practice Address - Phone:954-578-3167
Practice Address - Fax:954-578-3168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAZALTOV LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115273100Medicaid