Provider Demographics
NPI:1205358215
Name:JOE MAZZUCCO OT PLLC
Entity Type:Organization
Organization Name:JOE MAZZUCCO OT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MAZZUCCO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:203-980-9131
Mailing Address - Street 1:3 E EVERGREEN RD
Mailing Address - Street 2:PMB 563
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5101
Mailing Address - Country:US
Mailing Address - Phone:203-980-9131
Mailing Address - Fax:
Practice Address - Street 1:27 CHILTON LN
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2208
Practice Address - Country:US
Practice Address - Phone:203-980-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014843252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency