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General NPI Number Information
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NPI Number | 1194704601
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Entity Type | Individual
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Provider Name | THOMAS V MAZZILLI MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 111 MARYS AVE
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City | KINGSTON
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State | NY
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Zip | 12401-5852
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Country | US
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Telephone | 845-339-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 171 TECHNOLOGY DR SUITE 200
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City | BOALSBURG
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State | PA
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Zip | 16827-1530
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Country | US
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Telephone | 814-237-8627
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Fax | 814-238-0083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 198913
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License Number State | NY
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