Provider Demographics
NPI:1750302410
Name:MAZZA, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:MAZZA
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 1:316 E 30TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8366
Mailing Address - Country:US
Mailing Address - Phone:212-614-0089
Mailing Address - Fax:212-253-9631
Practice Address - Street 1:7 LEXINGTON AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5530
Practice Address - Country:US
Practice Address - Phone:212-677-7170
Practice Address - Fax:212-677-8501
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136247207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6710725004OtherCIGNA
80A881OtherBLUE CROSS POS PPO & SENI
010136247NY01OtherANTHEM HEALTH
010136247NY01OtherANTHEM HEALTH
80A881OtherBLUE CROSS POS PPO & SENI