Provider Demographics
NPI:1053724237
Name:MAZER, SUSAN JANE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:MAZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JANE
Other - Last Name:LOMBARDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:59 HARROW LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3538
Mailing Address - Country:US
Mailing Address - Phone:516-238-4655
Mailing Address - Fax:
Practice Address - Street 1:59 HARROW LN
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3538
Practice Address - Country:US
Practice Address - Phone:516-238-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY790632131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist