Provider Demographics
NPI:1467905232
Name:KAZDAN, MARCIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:KAZDAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1601
Mailing Address - Country:US
Mailing Address - Phone:631-364-9119
Mailing Address - Fax:631-509-4082
Practice Address - Street 1:6080 JERICHO TURNPIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1172
Practice Address - Country:US
Practice Address - Phone:631-364-9119
Practice Address - Fax:631-486-8361
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019721-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical