Provider Demographics
NPI:1962593384
Name:MAZZARA, GINA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:MAZZARA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 56TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4136
Mailing Address - Country:US
Mailing Address - Phone:212-935-1700
Mailing Address - Fax:212-753-9856
Practice Address - Street 1:300 E 56TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4136
Practice Address - Country:US
Practice Address - Phone:212-935-1700
Practice Address - Fax:212-753-9856
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008585-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO-8585-4OtherWORKERS COMPENSATION
NYP2129236OtherOXFORD
NY1013480OtherAMERICAN SPECIALTY HEALTH
NY89023OtherHEALTHNET
NYX93051OtherBLUE CROSS/BLUE SHIELD
NYU66889Medicare UPIN
NYX93051Medicare ID - Type Unspecified