MEDICARE: ROGER MAZLEN MD

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	207R00000X	Internal Medicine Physician	0925861	NY

General Provider Information

NPI Number	:	1831230168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER MAZLEN MD

Provider Business Mailing Address
First Line	:	30 MIDDLENECK RD
Second Line	:	1F
City	:	ROSLYN
State	:	NY
Zip	:	11576-1344
Country	:	US
Telephone Number	:	516-869-0717
Fax Number	:	516-869-0718

Provider Business Practice Location Address
First Line	:	30 MIDDLE NECK ROAD
Second Line	:	1F
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11576
Country	:	US
Telephone Number	:	516-869-0717
Fax Number	:	516-869-0718

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	11/04/2010

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