Provider Demographics
NPI:1205094885
Name:MLZ HEALTH CARE ASSOCIATES, LLC
Entity type:Organization
Organization Name:MLZ HEALTH CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZANDONELLA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-575-0349
Mailing Address - Street 1:17 PEPPERBUSH DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1168
Mailing Address - Country:US
Mailing Address - Phone:860-669-5302
Mailing Address - Fax:860-669-5302
Practice Address - Street 1:17 PEPPERBUSH DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-1168
Practice Address - Country:US
Practice Address - Phone:860-669-5302
Practice Address - Fax:860-669-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100000021Medicare PIN