Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 162022 | NY |
N | 111NI0900X | Internist | 162022 | NY |
N | 207RA0401X | Internist - Addiction Medicine | 25MA08425900 | NJ |
NPI | 1366417677 |
---|---|
Provider Name | Dr. Paul Carmine Gazzara |
First Address | Staten Island, NY 10308-3513 |
Second Address | Staten Island, NY 10308-3513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A63840 | (02) | NY |
BG0450813 | DEA # (01) | NY |