Provider Demographics
NPI:1922243104
Name:MAZZUCCO, JOSEPH F (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:MAZZUCCO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 E EVERGREEN RD
Mailing Address - Street 2:PMB 563
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5101
Mailing Address - Country:US
Mailing Address - Phone:203-980-9131
Mailing Address - Fax:
Practice Address - Street 1:27 CHILTON LN
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2208
Practice Address - Country:US
Practice Address - Phone:203-980-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014843225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics