NPI 1003104456

Mazurov Medical PC

Organisation Specialist Staten Island, NY

Practice location

Address: 505 Jefferson Blvd, Staten Island, NY 10312-2225
Phone: (718) 966-1738

Authorised official

Name: Boris Mazurov
Title: Owner
Phone: (718) 966-1738

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 210722-1 (NY)

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Registry record

NPI: 1003104456
Entity type: Organization
NPI issued: 19 Jul 2011
Record last updated: 19 Jul 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.