Provider Demographics
NPI:1407999428
Name:MAZZILLI, RENE (RN)
Entity Type:Individual
Prefix:MISS
First Name:RENE
Middle Name:
Last Name:MAZZILLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 90TH ST
Mailing Address - Street 2:APT G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5240
Mailing Address - Country:US
Mailing Address - Phone:646-707-3183
Mailing Address - Fax:
Practice Address - Street 1:303 E 90TH ST
Practice Address - Street 2:APT G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5240
Practice Address - Country:US
Practice Address - Phone:646-707-3183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576256163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse