Provider Demographics
NPI:1619083763
Name:MAZUREK, ALAN A (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:A
Last Name:MAZUREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 JERICHO TPKE STE 206
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1015
Mailing Address - Country:US
Mailing Address - Phone:516-338-2908
Mailing Address - Fax:516-333-6160
Practice Address - Street 1:99 JERICHO TPKE STE 206
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753
Practice Address - Country:US
Practice Address - Phone:516-338-2908
Practice Address - Fax:516-333-6160
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14980312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
03547800540OtherME NUMBER
NY00832408Medicaid
03547800540OtherME NUMBER
B10739Medicare UPIN