Provider Demographics
NPI:1952861932
Name:MAZNIKU, ERVIN
Entity Type:Individual
Prefix:
First Name:ERVIN
Middle Name:
Last Name:MAZNIKU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5306
Mailing Address - Country:US
Mailing Address - Phone:347-506-7015
Mailing Address - Fax:
Practice Address - Street 1:5850 78TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5306
Practice Address - Country:US
Practice Address - Phone:347-506-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health