MEDICARE: ALEXANDER MAZUROVSKY D.C.

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	X009550	NY

General Provider Information

NPI Number	:	1578572046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER MAZUROVSKY D.C.

Provider Business Mailing Address
First Line	:	4 ARKANSAS AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-1502
Country	:	US
Telephone Number	:	718-966-5851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4045
Country	:	US
Telephone Number	:	718-645-7733
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/14/2009

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