Provider Demographics
NPI:1487773719
Name:MAZUR, CAROLYN S (MPT, ATC, ART)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:MAZUR
Suffix:
Gender:F
Credentials:MPT, ATC, ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 READE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 READE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1844
Practice Address - Country:US
Practice Address - Phone:212-924-4920
Practice Address - Fax:212-924-0225
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41467225100000X
NY20721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP2851Medicare PIN