Provider Demographics
NPI:1285639518
Name:DHAFIR, MAZIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZIN
Middle Name:A
Last Name:DHAFIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4085 SENECA ST
Mailing Address - Street 2:STE 3
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3000
Mailing Address - Country:US
Mailing Address - Phone:716-674-1180
Mailing Address - Fax:716-674-2037
Practice Address - Street 1:4085 SENECA ST
Practice Address - Street 2:STE 3
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3000
Practice Address - Country:US
Practice Address - Phone:716-674-1180
Practice Address - Fax:716-674-2037
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154861-1207N00000X, 207NS0135X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070001676OtherMEDICARE TRAVELERS
NY161271451OtherCOMMERCIAL CLAIMS
NY00010045001OtherUNIVERA
NY161271451OtherEMPIRE
NY000502109001OtherBLUE CROSS
NY4464532OtherAETNA
NY0301846OtherINDEPENDENT HEALTH
NYP11129370OtherMULTIPLAN
NY161271451OtherUNITED HEALTHCARE
NY161271451OtherEMPIRE
NY4464532OtherAETNA