Provider Demographics
NPI:1952154445
Name:HAZEL, COLLETTE
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:
Last Name:HAZEL
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 1:796 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4806
Mailing Address - Country:US
Mailing Address - Phone:917-854-4248
Mailing Address - Fax:
Practice Address - Street 1:796 ESSEX ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4806
Practice Address - Country:US
Practice Address - Phone:917-854-4248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist