Provider Demographics
NPI:1902210677
Name:HAZEL, RICHARD (DAC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HAZEL
Suffix:
Gender:M
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SENECA ST APT 3-17
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-1988
Mailing Address - Country:US
Mailing Address - Phone:917-664-1966
Mailing Address - Fax:
Practice Address - Street 1:2733 WEHRLE DR # 3F
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7348
Practice Address - Country:US
Practice Address - Phone:716-219-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005308171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist