Individual provider Active NPI

Lucille Citera Mazzer, P.T.

  • Specialist
  • Wantagh, NY
National Provider Identifier
1669657672
Registry record updated Oct 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
7342 Issued in NY
Practice address
2969 Post Ave
Wantagh, NY 11793-3222
Phone
(516) 783-5011
NPI assigned
Jan 9, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 7342 NY Primary

Addresses

Primary practice location

2969 Post Ave
Wantagh, NY 11793-3222

Mailing address

2969 Post Ave
Wantagh, NY 11793-3222
Phone (516) 783-5011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131017000544 NY Practitioner - Physical Therapist in Private Practice 6709010101 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7342NYMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Priority One Therapy PT OT SLP PLLC CurrentSince Jun 15, 2019 Accepting new patients
Home Advantage Physical Therapy PC CurrentSince Jan 1, 2022 Accepting new patients

Locations

7120 110th St
Forest Hills, NY 11375
Phone (718) 305-1190

99 W Hawthorne Ave
Ste 210
Valley Stream, NY 11580
Phone (718) 305-1190

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256515200000",
    "number": "1669657672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2969 POST AVE",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117933222",
            "telephone_number": "516-783-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2969 POST AVE",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117933222",
            "telephone_number": "516-783-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CITERA MAZZER",
        "first_name": "LUCILLE",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-09",
        "last_updated": "2009-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "7342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wantagh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.