Individual
DR. THOMAS V MAZZILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 MARYS AVE, KINGSTON, NY 12401-5852
(845) 339-7700
Mailing address
171 TECHNOLOGY DR, SUITE 200, BOALSBURG, PA 16827-1530
(814) 237-8627
(814) 238-0083
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
198913
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000075925
GHI HMO
NY
01
—
000499970001
BCBS NE NY
NY
01
—
000499970002
BCBS NE NY
NY
01
—
000499970004
BCBS NENY
NY
05
—
01655361
—
NY
01
—
10063093
CDPHP
NY
01
—
2065E1
EMPIRE BCBS
NY
01
—
2067E1
EMPIRE BCBS
NY
01
—
361786
MVP
NY
01
—
402509
MVP
NY
01
—
4099576
GHI PPO
NY
Enumeration date
01/12/2006
Last updated
01/15/2010
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