Healthcare Provider Details

I. General information

NPI: 1235209461
Provider Name (Legal Business Name): DANIEL MAZZUCHIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 48TH ST 2ND FLOOR
BROOKLYN NY
11219-2918
US

IV. Provider business mailing address

2130 STUART ST
BROOKLYN NY
11229-4018
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number008598
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: