Individual
DEREK MAZIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5141 BROADWAY, NEW YORK, NY 10034
(212) 932-5218
(212) 932-5458
Mailing address
630 W 168TH ST # 4, NEW YORK, NY 10032-3725
(212) 932-5218
(212) 932-5458
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
288108
NY
Other
Enumeration date
04/07/2014
Last updated
09/05/2024
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