Provider Demographics
NPI:1972601326
Name:MAZUR, JILL G (MA)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:G
Last Name:MAZUR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1530
Mailing Address - Country:US
Mailing Address - Phone:716-282-4130
Mailing Address - Fax:716-282-4133
Practice Address - Street 1:549 4TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1530
Practice Address - Country:US
Practice Address - Phone:716-282-4130
Practice Address - Fax:716-282-4133
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1064231H00000X
NY15000000829231HA2400X
NY14000002100231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005760313OtherBLUE CROSS/SHIELD
NY01112954Medicaid
NY00011183301OtherUNIVERA
NY9209410OtherINDEPENDENT HEALTH
NY060725000001OtherFIDELIS CARE
NY01112954Medicaid