Healthcare Provider Details

I. General information

NPI: 1255380879
Provider Name (Legal Business Name): YURI MAZUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: IOURII MAZOUR M.D.

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MOLSBURY LN
MILLSTONE TOWNSHIP NJ
08510-8763
US

IV. Provider business mailing address

17 MOLSBURY LN
MILLSTONE TOWNSHIP NJ
08510-8763
US

V. Phone/Fax

Practice location:
  • Phone: 732-491-5314
  • Fax:
Mailing address:
  • Phone: 732-491-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA07878500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: