Healthcare Provider Details

I. General information

NPI: 1750302410
Provider Name (Legal Business Name): DAVID S MAZZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 LEXINGTON AVENUE SUITE 3
NEW YORK NY
10010-5530
US

IV. Provider business mailing address

316 E 30TH ST FL 2
NEW YORK NY
10016-8366
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-7170
  • Fax: 212-677-8501
Mailing address:
  • Phone: 212-614-0089
  • Fax: 212-253-9631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number136247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: