Provider Demographics
NPI:1144590811
Name:MAZON LLC
Entity Type:Organization
Organization Name:MAZON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-402-7474
Mailing Address - Street 1:87 WHARTON DR
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7430
Mailing Address - Country:US
Mailing Address - Phone:914-402-7474
Mailing Address - Fax:914-402-7470
Practice Address - Street 1:87 WHARTON DR
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-7430
Practice Address - Country:US
Practice Address - Phone:914-402-7474
Practice Address - Fax:914-402-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care