Provider Demographics
NPI:1720029572
Name:EZZAT, AZZA A (NP)
Entity Type:Individual
Prefix:MRS
First Name:AZZA
Middle Name:A
Last Name:EZZAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 RATHBUN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2409
Mailing Address - Country:US
Mailing Address - Phone:717-716-7107
Mailing Address - Fax:718-494-6572
Practice Address - Street 1:796 RATHBUN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2409
Practice Address - Country:US
Practice Address - Phone:717-716-7107
Practice Address - Fax:717-716-7107
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily