Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1710398706 |
---|---|
Provider Name | Damiano Mazza |
First Address | Elmwood Park, NJ 07407-1243 |
Second Address | Elmwood Park, NJ 07407-1243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 24/10/2014 |