Provider Demographics
NPI:1477871556
Name:LIZ, JAZEL
Entity type:Individual
Prefix:MS
First Name:JAZEL
Middle Name:
Last Name:LIZ
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 1:748 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5106
Mailing Address - Country:US
Mailing Address - Phone:718-294-1083
Mailing Address - Fax:718-294-1370
Practice Address - Street 1:748 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5106
Practice Address - Country:US
Practice Address - Phone:718-294-1083
Practice Address - Fax:718-294-1370
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009078156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician