Provider Demographics
NPI:1396921912
Name:DR. ROBERT MAZZA,DC
Entity type:Organization
Organization Name:DR. ROBERT MAZZA,DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-432-8531
Mailing Address - Street 1:854 W SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-6514
Mailing Address - Country:US
Mailing Address - Phone:201-432-8531
Mailing Address - Fax:201-432-3404
Practice Address - Street 1:854 W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-6514
Practice Address - Country:US
Practice Address - Phone:201-432-8531
Practice Address - Fax:201-432-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00169700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1182803Medicaid
NJ1182803Medicaid