MEDICARE: DR. ROBERT MAZZA,DC

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	111N00000X	Chiropractor	38MC00169700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396921912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ROBERT MAZZA,DC

Provider Business Mailing Address
First Line	:	854 W SIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6514
Country	:	US
Telephone Number	:	201-432-8531
Fax Number	:	201-432-3404

Provider Business Practice Location Address
First Line	:	854 W SIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6514
Country	:	US
Telephone Number	:	201-432-8531
Fax Number	:	201-432-3404

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT MAZZA
Credential	:	DC
Telephone Number	:	201-432-8531

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/14/2008

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