Provider Demographics
NPI:1891713384
Name:KAZAM MD, EZRA S
Entity Type:Individual
Prefix:
First Name:EZRA
Middle Name:S
Last Name:KAZAM MD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EZRA
Other - Middle Name:S
Other - Last Name:KAZAM MD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 WASHINGTON PLACE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-267-8755
Mailing Address - Fax:973-267-8755
Practice Address - Street 1:2 WASHINGTON PLACE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-267-8755
Practice Address - Fax:973-267-8755
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ326AL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0713100001Medicare NSC
KA29030Medicare ID - Type Unspecified
C52647Medicare UPIN