Provider Demographics
NPI:1093156887
Name:MAZA, ROBIN FAY (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:FAY
Last Name:MAZA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:289 PROSPECT PARK W
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6670
Mailing Address - Country:US
Mailing Address - Phone:203-536-2810
Mailing Address - Fax:
Practice Address - Street 1:37 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3007
Practice Address - Country:US
Practice Address - Phone:203-536-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005061171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist