Provider Demographics
NPI:1699535112
Name:MAZUR, ALINA
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:MAZUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 GREGORY PL
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2905
Mailing Address - Country:US
Mailing Address - Phone:631-655-1098
Mailing Address - Fax:
Practice Address - Street 1:730 GREGORY PL
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2905
Practice Address - Country:US
Practice Address - Phone:631-655-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician