Mazzillo, Justin Adam

Mazzillo, Justin Adam is an individual health care provider with primary practice located at 590 Court St , Keene NH 03431-1719. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Mazzillo, Justin Adam can be contacted via phone (603) 354-5454.

Contact Information

Primary practice address
590 Court St Keene NH 03431-1719
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X P1670 Texas
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 16046 New Hampshire

Profile Details

NPI number 1487924304
LBN Legal business name Mazzillo, Justin Adam
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2012
Last updated Aug 28th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487924304 NPPES
New Hampshire MEDICAID 3085790

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