Basic Information
| Provider Information | |||||||||
| NPI: | 1346851755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZUREK | ||||||||
| FirstName: | LUCAS | ||||||||
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| Credential: | DPT, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1377 MOTOR PKWY STE 307 | ||||||||
| Address2: | |||||||||
| City: | ISLANDIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117495258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315805200 | ||||||||
| FaxNumber: | 6317608306 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 GODWIN AVE | ||||||||
| Address2: | |||||||||
| City: | MIDLAND PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074321970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016398870 | ||||||||
| FaxNumber: | 2016398874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2020 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01938900 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.