Provider Demographics
NPI:1003464660
Name:EZAGUI, NECHAMA DINA (PA-S)
Entity type:Individual
Prefix:
First Name:NECHAMA
Middle Name:DINA
Last Name:EZAGUI
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 PRESIDENT ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1665
Mailing Address - Country:US
Mailing Address - Phone:347-413-3190
Mailing Address - Fax:
Practice Address - Street 1:1227 PRESIDENT ST APT 2B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1665
Practice Address - Country:US
Practice Address - Phone:347-413-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant