Active NPI
Mimma Alessandra Mazzola, PA-C
- Physician Assistant
- Melville, NY
National Provider Identifier
1356975411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 025302
- Practice address
- 510 Broadhollow Rd
Melville, NY 11747-3671 - Phone
- (631) 424-3600
- NPI assigned
- Feb 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 025302 | NY | Primary |
Addresses
Primary practice location
510 Broadhollow Rd
Melville, NY 11747-3671
Mailing address
2018 Henry St
North Bellmore, NY 11710-3216
Phone (718) 570-6889
Other practice location 1
259 1st St
Mineola, NY 11501-3957
Phone (516) 663-0333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
501 Broadhollow Rd
Suite 100
Melville, NY 11747-3710
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025302 | NY | MD | Physician Assistant |
Interoperability endpoints
- mkaplan607860@nyumc.direct-ci.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Plastic Surgery Physician
- Melville, NY
- NPI 1992080352
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715040000000",
"number": "1356975411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2018 HENRY ST",
"city": "NORTH BELLMORE",
"state": "NY",
"postal_code": "117103216",
"telephone_number": "718-570-6889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 BROADHOLLOW RD",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117473671",
"telephone_number": "631-424-3600"
}
],
"practiceLocations": [
{
"address_1": "259 1st St",
"address_purpose": "LOCATION",
"city": "Mineola",
"state": "NY",
"postal_code": "115013957",
"country_code": "US",
"telephone_number": "516-663-0333",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAZZOLA",
"first_name": "MIMMA",
"middle_name": "ALESSANDRA",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-27",
"last_updated": "2024-05-07",
"certification_date": "2024-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "025302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.