Provider Demographics
NPI:1053694919
Name:MAZIN, BRACHA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRACHA
Middle Name:
Last Name:MAZIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 OVERLOOK AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2285
Mailing Address - Country:US
Mailing Address - Phone:201-645-4336
Mailing Address - Fax:201-917-1452
Practice Address - Street 1:160 OVERLOOK AVE STE 1A
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2285
Practice Address - Country:US
Practice Address - Phone:201-645-4336
Practice Address - Fax:201-917-1452
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00114100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical