Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | X010739 | NY |
NPI | 1154680239 |
---|---|
Provider Name | Dr. Nathaniel Mazza |
First Address | Englishtown, NJ 07726-4258 |
Second Address | Englishtown, NJ 07726-4258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2012 |
Last Update Date | 10/05/2012 |