Provider Demographics
NPI:1134185135
Name:MAZURE, BRIAN (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MAZURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GLEN COVE RD
Mailing Address - Street 2:301
Mailing Address - City:ROSLYN HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1726
Mailing Address - Country:US
Mailing Address - Phone:516-621-1502
Mailing Address - Fax:516-621-1162
Practice Address - Street 1:70 GLEN COVE RD #301
Practice Address - Street 2:
Practice Address - City:ROSLYN HGTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1726
Practice Address - Country:US
Practice Address - Phone:516-621-1502
Practice Address - Fax:516-621-1162
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2352041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYL45739Medicare PIN
NY1655S14511Medicare PIN