Provider Demographics
NPI:1073386082
Name:GAZ, RIVKA MIRIAM
Entity Type:Individual
Prefix:MISS
First Name:RIVKA
Middle Name:MIRIAM
Last Name:GAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4405
Mailing Address - Country:US
Mailing Address - Phone:646-659-1365
Mailing Address - Fax:
Practice Address - Street 1:1257 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1928
Practice Address - Country:US
Practice Address - Phone:718-686-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003184103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst