Individual
LISA MAZZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2510 30TH AVE, LONG ISLAND CITY, NY 11102-2448
(718) 267-4245
Mailing address
627 DONNA DR, OYSTER BAY, NY 11771-4512
(516) 922-7390
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
005839
NY
Other
Enumeration date
04/02/2007
Last updated
07/08/2007
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