Healthcare Provider Details

I. General information

NPI: 1235606005
Provider Name (Legal Business Name): WILLIAM M MAZARIEGO ATS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TALLMAN PL
SUFFERN NY
10901
US

IV. Provider business mailing address

5 TALLMAN PL P.O BOX 675
SUFFERN NY
10901
US

V. Phone/Fax

Practice location:
  • Phone: 845-300-8066
  • Fax:
Mailing address:
  • Phone: 845-300-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: