Provider Demographics
NPI:1598877276
Name:MAZING, MARIA Y (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:Y
Last Name:MAZING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-2961
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-2961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46251207R00000X
NY242518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1040811OtherPREFERRED ONE
264KOMAOtherBLUE CROSS BLUE SHIELD
0406568OtherMEDICA
164622OtherUCARE MINNESOTA
2421660OtherAMERICAS PPO
1040811OtherPREFERRED ONE
WI34503400Medicare ID - Type Unspecified