Provider Demographics
NPI:1326223967
Name:MAZZA, RONALD P (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:P
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 1:56A MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4038
Mailing Address - Country:US
Mailing Address - Phone:516-752-1910
Mailing Address - Fax:516-752-1914
Practice Address - Street 1:56A MOTOR AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4038
Practice Address - Country:US
Practice Address - Phone:516-752-1910
Practice Address - Fax:516-752-1914
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08356GMedicare PIN
NYX2133XTYN1Medicare PIN