Provider Demographics
NPI:1487751848
Name:DR. RONALD P. MAZZA, DC, PC
Entity type:Organization
Organization Name:DR. RONALD P. MAZZA, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-752-1910
Mailing Address - Street 1:56A MOTOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:516-752-1910
Mailing Address - Fax:516-752-1914
Practice Address - Street 1:56A MOTOR AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:516-752-1910
Practice Address - Fax:516-752-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX2133XTYN1Medicare PIN
NYWXTYN1Medicare PIN