Provider Demographics
NPI:1497196471
Name:MAZZA, KATHRYN LEIGH (DO)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LEIGH
Last Name:MAZZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:FL 12
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:
Practice Address - Street 1:1591 BOSTON POST RD STE 100
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4335
Practice Address - Country:US
Practice Address - Phone:203-453-9911
Practice Address - Fax:203-458-1905
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY289426207Q00000X
CT079272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine