Healthcare Provider Details

I. General information

NPI: 1972601326
Provider Name (Legal Business Name): JILL G. MAZUR M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 4TH ST
NIAGARA FALLS NY
14301-1530
US

IV. Provider business mailing address

549 4TH ST
NIAGARA FALLS NY
14301-1530
US

V. Phone/Fax

Practice location:
  • Phone: 716-282-4130
  • Fax: 716-282-4133
Mailing address:
  • Phone: 716-282-4130
  • Fax: 716-282-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1064
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number15000000829
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number14000002100
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: