Healthcare Provider Details

I. General information

NPI: 1043753908
Provider Name (Legal Business Name): NICHOLAS MAZZONE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CENTRAL AVE
CLARK NJ
07066-1121
US

IV. Provider business mailing address

218 ELIZABETH AVE
CRANFORD NJ
07016-2423
US

V. Phone/Fax

Practice location:
  • Phone: 732-943-5033
  • Fax:
Mailing address:
  • Phone: 718-216-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number041101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: