Provider Demographics
NPI:1174527543
Name:MAZZARA, CARL (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:MAZZARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:485 ROUTE 1 SOUTH
Practice Address - Street 2:SUITE 350
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-549-3934
Practice Address - Fax:732-549-7250
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA053508174400000X
NJ25MA05350800207Y00000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
223561248002OtherQUALCARE
0388738002OtherCIGNA
0954673OtherAETNA
0699933OtherGHI
1275684OtherUNITED HEALTHCARE
223561248OtherHORIZON BCBS
598151OtherAMERIHEALTH
LS356OtherOXFORD
OK4425OtherHEALTHNET
0388738002OtherCIGNA
NJ673748Medicare ID - Type Unspecified