Provider Demographics
NPI:1154680239
Name:MAZZA, NATHANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:MAZZA
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 1:12 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-4258
Mailing Address - Country:US
Mailing Address - Phone:732-446-4851
Mailing Address - Fax:
Practice Address - Street 1:12 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-4258
Practice Address - Country:US
Practice Address - Phone:732-446-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010739111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician