1457599797 NPI number — DR. NICOLE ALIZA MAZER M.D.

Table of content: DR. NICOLE ALIZA MAZER M.D. (NPI 1457599797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457599797 NPI number — DR. NICOLE ALIZA MAZER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAZER
Provider First Name:
NICOLE
Provider Middle Name:
ALIZA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRISS
Provider Other First Name:
NICOLE
Provider Other Middle Name:
ALIZA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457599797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 WHITE PLAINS RD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARRYTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-5107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-984-2546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN SQUARE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11010-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-355-0505
Provider Business Practice Location Address Fax Number:
516-355-2055
Provider Enumeration Date:
01/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X , with the licence number:  248591 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)