Provider Demographics
NPI:1982152807
Name:MAZZARA, GASPER
Entity Type:Individual
Prefix:MR
First Name:GASPER
Middle Name:
Last Name:MAZZARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 STENZIL ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2620
Mailing Address - Country:US
Mailing Address - Phone:716-204-5925
Mailing Address - Fax:716-204-5926
Practice Address - Street 1:184 STENZIL ST APT 3B
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2620
Practice Address - Country:US
Practice Address - Phone:716-204-5925
Practice Address - Fax:716-204-5926
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator