Provider Demographics
NPI:1629348784
Name:MAZIARZ, ANASTATAZJA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASTATAZJA
Middle Name:
Last Name:MAZIARZ
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 1:29 CLYDE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5040
Mailing Address - Country:US
Mailing Address - Phone:732-873-0330
Mailing Address - Fax:732-873-2077
Practice Address - Street 1:29 CLYDE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5040
Practice Address - Country:US
Practice Address - Phone:732-873-0330
Practice Address - Fax:732-873-2077
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09242100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ336059Medicare PIN