Healthcare Provider Details

I. General information

NPI: 1881664886
Provider Name (Legal Business Name): ERIC M MAZUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STEVENS ST
NORWALK CT
06850-3852
US

IV. Provider business mailing address

280 NEWTOWN TPKE
WESTON CT
06883-1320
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2368
  • Fax: 203-855-3589
Mailing address:
  • Phone: 203-952-5929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021096
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number021096
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: