Provider Demographics
NPI:1538469291
Name:JOHN S. MAZELLA, M.D., P.C.
Entity Type:Organization
Organization Name:JOHN S. MAZELLA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:MAZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-241-1808
Mailing Address - Street 1:37 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3127
Mailing Address - Country:US
Mailing Address - Phone:914-241-1808
Mailing Address - Fax:914-241-4789
Practice Address - Street 1:37 MOORE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3127
Practice Address - Country:US
Practice Address - Phone:914-241-1808
Practice Address - Fax:914-241-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092018-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY447411Medicare PIN