Provider Demographics
NPI:1871841874
Name:MAZZO, KRISTINE MARIA (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:MARIA
Last Name:MAZZO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6037
Mailing Address - Country:US
Mailing Address - Phone:917-974-2039
Mailing Address - Fax:
Practice Address - Street 1:39 WINTER ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6037
Practice Address - Country:US
Practice Address - Phone:917-974-2039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015908363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant