MEDICARE: MRS. ANGELA M MAZZEO MSED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	851521	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	851521	OTHER	NY	CERTIFICATIONS

General Provider Information

NPI Number	:	1003178161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA M MAZZEO MSED

Provider Business Mailing Address
First Line	:	1967 HANCOCK AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1514
Country	:	US
Telephone Number	:	917-576-6884
Fax Number	:

Provider Business Practice Location Address
First Line	:	1967 HANCOCK AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1514
Country	:	US
Telephone Number	:	917-576-6884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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