Provider Demographics
NPI:1548060924
Name:MAZARA EARLY IMPACT LLC
Entity type:Organization
Organization Name:MAZARA EARLY IMPACT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMADHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZARA
Authorized Official - Suffix:
Authorized Official - Credentials:BSED, MSPED
Authorized Official - Phone:646-220-4787
Mailing Address - Street 1:19217 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2406
Mailing Address - Country:US
Mailing Address - Phone:646-220-4787
Mailing Address - Fax:
Practice Address - Street 1:19217 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2406
Practice Address - Country:US
Practice Address - Phone:646-220-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency