Provider Demographics
NPI:1356320410
Name:HIJAZIN, EYAD MICHEL (MD)
Entity Type:Individual
Prefix:
First Name:EYAD
Middle Name:MICHEL
Last Name:HIJAZIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3500
Mailing Address - Country:US
Mailing Address - Phone:914-834-1777
Mailing Address - Fax:914-834-0047
Practice Address - Street 1:2365 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3500
Practice Address - Country:US
Practice Address - Phone:914-834-1777
Practice Address - Fax:914-834-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230232207R00000X
CT041643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02611310Medicaid
NY97S681Medicare ID - Type Unspecified
NY02611310Medicaid