Provider Demographics
NPI:1467058131
Name:MAZON, VICTORIA (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MAZON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WINCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4352
Mailing Address - Country:US
Mailing Address - Phone:201-230-2557
Mailing Address - Fax:
Practice Address - Street 1:156 WINCHESTER CT
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-4352
Practice Address - Country:US
Practice Address - Phone:201-230-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01084000363LF0000X
NY346851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily