Provider Demographics
NPI:1013138825
Name:MAZZIE, JOSEPH PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:MAZZIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27686
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7686
Mailing Address - Country:US
Mailing Address - Phone:888-220-1235
Mailing Address - Fax:865-450-9374
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 10 LOWER LEVEL
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4073
Practice Address - Country:US
Practice Address - Phone:516-663-4510
Practice Address - Fax:516-663-3698
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ25MB099907002085R0202X
MDH00653902085R0202X
NY2452062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412895800Medicaid
NYJM060DO720Medicare PIN
MD865LR401Medicare PIN
MDH380Q661Medicare PIN