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General NPI Number Information
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NPI Number | 1376739730
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Entity Type | Organization
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Legal Business Name | BORIS MAYZLER DO LLC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 70 MILL RIVER ST
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City | STAMFORD
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State | CT
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Zip | 06902-3725
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Country | US
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Telephone | 203-961-0063
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Fax | 203-961-0064
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Provider Business Mailing Address
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Address Line | 70 MILL RIVER ST
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City | STAMFORD
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State | CT
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Zip | 06902-3725
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Country | US
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Telephone | 203-961-0063
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Fax | 203-961-0064
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Authorized Official
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Title or Position | OWNER
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Name | DR. BORIS MAYZLER
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Credential | D O
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Telephone | 203-961-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 038982
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License Number State | CT
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