NPIMap

Organization Active NPI

Mazurov Medical PC

  • Specialist
  • Staten Island, NY
National Provider Identifier
1003104456
Registry record updated Jul 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
210722-1 Issued in NY
Legal business name
MAZUROV MEDICAL PC
Practice address
505 Jefferson Blvd
Staten Island, NY 10312-2225
Phone
(718) 966-1738
NPI assigned
Jul 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Boris Mazurov, MD
Title
Owner
Phone
(718) 966-1738

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 210722-1 NY Primary

Addresses

Primary practice location

505 Jefferson Blvd
Staten Island, NY 10312-2225

Mailing address

505 Jefferson Blvd
Staten Island, NY 10312-2225

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311033600000",
    "number": "1003104456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 JEFFERSON BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103122225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 JEFFERSON BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103122225",
            "telephone_number": "718-966-1738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAZUROV MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-19",
        "last_updated": "2011-07-19",
        "status": "A",
        "authorized_official_last_name": "MAZUROV",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-966-1738",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "210722-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.