Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 211575 | NY |
Y | 208600000X | Surgeon | 211575 | NY |
NPI | 1003820366 |
---|---|
Provider Name | Alexes Hazen |
First Address | New York, NY 10017-3662 |
Second Address | New York, NY 10017-3662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H789991 | (02) | NY |