MEDICARE: DR. CARL MAZZARA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA053508	NJ
2	207Y00000X	Otolaryngology Physician	25MA05350800	NJ
3	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	25MA05350800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	223561248002	OTHER	QUALCARE
2	0388738002	OTHER	CIGNA
3	0954673	OTHER	AETNA
4	0699933	OTHER	GHI
5	1275684	OTHER	UNITED HEALTHCARE
6	223561248	OTHER	HORIZON BCBS
7	598151	OTHER	AMERIHEALTH
8	LS356	OTHER	OXFORD
9	OK4425	OTHER	HEALTHNET

General Provider Information

NPI Number	:	1174527543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL MAZZARA M.D.

Provider Business Mailing Address
First Line	:	660 WHITE PLAINS RD FL 4
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5139
Country	:	US
Telephone Number	:	914-984-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 ROUTE 1 SOUTH
Second Line	:	SUITE 350
City	:	ISELIN
State	:	NJ
Zip	:	08830
Country	:	US
Telephone Number	:	732-549-3934
Fax Number	:	732-549-7250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/12/2019

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Directions to “ DR. CARL MAZZARA M.D.” Practice Location

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