Provider Demographics
NPI:1124559497
Name:CHALET, MIRA YAZIGI (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRA
Middle Name:YAZIGI
Last Name:CHALET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRA
Other - Middle Name:
Other - Last Name:YAZIGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:32 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1046
Mailing Address - Country:US
Mailing Address - Phone:973-452-5085
Mailing Address - Fax:
Practice Address - Street 1:177 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1311
Practice Address - Country:US
Practice Address - Phone:201-487-8222
Practice Address - Fax:201-487-2126
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
NJ25MA10833700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty