Provider Demographics
NPI:1639535180
Name:MAZZARISI, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MAZZARISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PATTON CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7950
Mailing Address - Country:US
Mailing Address - Phone:718-744-7325
Mailing Address - Fax:
Practice Address - Street 1:528 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1921
Practice Address - Country:US
Practice Address - Phone:718-477-4500
Practice Address - Fax:718-227-5402
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345459-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse