Provider Demographics
NPI:1578572046
Name:MAZUROVSKY, ALEXANDER (DC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:MAZUROVSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1502
Mailing Address - Country:US
Mailing Address - Phone:718-966-5851
Mailing Address - Fax:
Practice Address - Street 1:2333 65TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4045
Practice Address - Country:US
Practice Address - Phone:718-645-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor