Provider Demographics
NPI:1417757196
Name:MAZUERA, MAGDA M I
Entity type:Individual
Prefix:
First Name:MAGDA
Middle Name:M
Last Name:MAZUERA
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:MAGDA
Other - Middle Name:
Other - Last Name:ROTHMAN
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29-10 137 STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:929-634-1436
Mailing Address - Fax:
Practice Address - Street 1:2910 137TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2054
Practice Address - Country:US
Practice Address - Phone:929-634-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPARAPROFESIONAL376J00000X
NYPAPAPROFESIONAL376J00000X
NY347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle