Provider Demographics
NPI:1417038753
Name:MAYZLER, BORIS (DO,MD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:MAYZLER
Suffix:
Gender:M
Credentials:DO,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MORGAN ST
Mailing Address - Street 2:SUITE1
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5433
Mailing Address - Country:US
Mailing Address - Phone:203-961-0063
Mailing Address - Fax:203-961-0064
Practice Address - Street 1:144 MORGAN ST
Practice Address - Street 2:SUITE1
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5433
Practice Address - Country:US
Practice Address - Phone:203-961-0063
Practice Address - Fax:203-961-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT038982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH41802Medicare UPIN