Provider Demographics
NPI:1023028362
Name:DRAZEN, MYRON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:
Last Name:DRAZEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BLDG 5D
Mailing Address - City:STONYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-689-7979
Mailing Address - Fax:631-471-9085
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:BLDG 5D
Practice Address - City:STONYBROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-689-7979
Practice Address - Fax:631-471-9085
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006929103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00727633Medicaid
NYV29531Medicare ID - Type Unspecified
NY00727633Medicaid