Provider Demographics
NPI:1558413138
Name:ESHKENAZI, AZARIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:AZARIAH
Middle Name:
Last Name:ESHKENAZI
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 1:114-06 QUEENS BOULEVARD
Mailing Address - Street 2:FOREST HILLS SUITE A-1
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-793-0505
Mailing Address - Fax:718-261-4983
Practice Address - Street 1:114-06 QUEENS BOULEVARD
Practice Address - Street 2:FOREST HILLS SUITE A-1
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-793-0505
Practice Address - Fax:718-261-4983
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12854312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
93237Medicare ID - Type Unspecified