Individual provider Active NPI

Mazal Agazarova, PT

  • Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1508188087
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
032297 Issued in NY
Practice address
3003 Avenue X
Apt 5F
Brooklyn, NY 11235-1249
Phone
(718) 908-6630
Fax
(718) 975-8637
NPI assigned
Feb 24, 2010
Last updated
Oct 27, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 032297 NY Primary

Addresses

Primary practice location

3003 Avenue X
Apt 5F
Brooklyn, NY 11235-1249

Mailing address

3003 Avenue X
Apt 5F
Brooklyn, NY 11235-1249
Phone (718) 908-6630

Other identifiers 1

IdentifierTypeStateIssuer
LICENSE#OtherNY032297-1

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100421000218 NY Practitioner - Physical Therapist in Private Practice 6507993656 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
My Medical PCGroup PAC ID 0143610600, 93 clinicians

Practice addresses (Care Compare)

147 2ND Ave
Brentwood, NY 11717-4809
Phone (631) 273-7204

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
032297NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
My Medical PC CurrentSince Dec 15, 2024 Accepting new patients
PT and OT for Senior Rehab at Home PLLC Physical Therapist CurrentSince Oct 27, 2021 Accepting new patients
Peyman Younesi MD PLLC CurrentSince Apr 19, 2023 Accepting new patients
Proactive Occupational Therapy PC Physical Therapist PastSince Apr 16, 2015 Accepting new patients
Hands on OT PLLC Physical Therapist PastSince Apr 24, 2023 Accepting new patients

Locations

3438 Bell Blvd
Ste 301
Bayside, NY 11361

147 2nd Ave
Brentwood, NY 11717
Phone (631) 273-7204

6355 Broadway
Bronx, NY 10471
Phone (718) 549-3300

171 Kings Hwy
Brooklyn, NY 11223
Phone (877) 722-7700

2830 Pitkin Ave
Brooklyn, NY 11208
Phone (347) 420-8295

8008 45th Ave
Ofc
Elmhurst, NY 11373

1526 New Haven Ave
Far Rockaway, NY 11691
Phone (718) 471-7200

8008 45th Ave
Flushing, NY 11373
Phone (718) 373-0777

9131 175th St
Jamaica, NY 11432
Phone (340) 709-3133

822 Cedar Ave
Niagara Falls, NY 14301
Phone (716) 272-1207

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1266969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1508188087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 AVENUE X",
            "address_2": "APT 5F",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112351249",
            "telephone_number": "718-908-6630",
            "fax_number": "718-975-8637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 AVENUE X",
            "address_2": "APT 5F",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112351249",
            "telephone_number": "718-908-6630",
            "fax_number": "718-975-8637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGAZAROVA",
        "first_name": "MAZAL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-24",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "032297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "032297-1",
            "identifier": "LICENSE#",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.