Provider Demographics
NPI:1134492234
Name:HAZAE, AHMED AJJEL (SPECIALIST ASSISTANT)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:AJJEL
Last Name:HAZAE
Suffix:
Gender:M
Credentials:SPECIALIST ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:2 SUITE
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4021
Mailing Address - Country:US
Mailing Address - Phone:845-638-0400
Mailing Address - Fax:845-638-1193
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:2 SUITE
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4021
Practice Address - Country:US
Practice Address - Phone:845-638-0400
Practice Address - Fax:845-638-1193
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist