MEDICARE: DR. TOM MAZUR PSY.D.

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	103TC0700X	Clinical Psychologist	007358	NY

General Provider Information

NPI Number	:	1003804949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM MAZUR PSY.D.

Provider Business Mailing Address
First Line	:	219 BRYANT ST
Second Line	:	BUFFALO
City	:	BUFFALO
State	:	NY
Zip	:	14222-2006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 BRYANT ST
Second Line	:	BUFFALO
City	:	BUFFALO
State	:	NY
Zip	:	14222-2006
Country	:	US
Telephone Number	:	716-878-7093
Fax Number	:	716-888-3827

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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