Provider Demographics
NPI:1568714384
Name:MAZAL PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:MAZAL PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MAZAL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAZAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-908-6630
Mailing Address - Street 1:3003 AVENUE X APT 5F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3003 AVENUE X APT 5F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1246
Practice Address - Country:US
Practice Address - Phone:718-908-6630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032297-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032297-1OtherLICENSE#