Provider Demographics
NPI:1073680666
Name:MOZINGO, GERALD J (DC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:MOZINGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 DELAWARE AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1728
Mailing Address - Country:US
Mailing Address - Phone:716-875-5070
Mailing Address - Fax:716-875-5073
Practice Address - Street 1:3247 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1728
Practice Address - Country:US
Practice Address - Phone:716-875-5070
Practice Address - Fax:716-875-5073
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0025841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0025843OtherWCB
T25886Medicare UPIN
NY081851Medicare ID - Type Unspecified