Provider Demographics
NPI:1780201137
Name:ELAZAZY, REEM H
Entity Type:Individual
Prefix:
First Name:REEM
Middle Name:H
Last Name:ELAZAZY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EVANS DR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-3011
Mailing Address - Country:US
Mailing Address - Phone:860-490-0568
Mailing Address - Fax:
Practice Address - Street 1:5 EVANS DR
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-3011
Practice Address - Country:US
Practice Address - Phone:860-490-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant