Amanda Mazzetta, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

25MP00208400 Issued in NJ

Practice address

1075 Central Ave
Clark, NJ 07066

Phone

(732) 574-1399

Fax

(732) 574-1433

NPI assigned

Oct 17, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda Tirado Former name

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clark Dermatology LLCGroup PAC ID 5395703573, 46 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: amanda.mazzetta@metroderm.eclinicaldirectplus.com

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.

• Clark Dermatology LLC

  • Dermatology Physician
  • Clark, NJ
  • NPI 1851562425
  Medicare reassignment Care Compare group
• Clark Dermatology, LLC

  • Dermatology Physician
  • Staten Island, NY
  • NPI 1417316274
  NPD (past)

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480464000000",
    "number": "1801048103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 CENTRAL AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "07066",
            "telephone_number": "732-574-1399",
            "fax_number": "732-574-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 CENTRAL AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "07066",
            "telephone_number": "732-574-1399",
            "fax_number": "732-574-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZETTA",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-17",
        "last_updated": "2016-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00208400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "TIRADO",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Flanagan LLC
• Mastermind Counseling Services, LLC
• Tania Mastropietro Cosmi
• Tricia Mastropietro, BA DC
• Maximum Health & Wellness Clark, LLC
• Nicholas Mazzone, DPT
• Sandra McGill, DNP,RN,FNP-BC,CCRN
• Betty C McLendon, PSYD
• Sophia McMullan
• Elaine A Melamud, M.D.

• Medical Physician Assistant in Clark, NJ
• Providers in Clark, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.

Verify at the official NPI Registry.