Provider Demographics
NPI:1952413809
Name:HAZAN, MARC B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:B
Last Name:HAZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 W CARVER STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-421-0020
Mailing Address - Fax:631-421-5991
Practice Address - Street 1:200 W CARVER STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-421-0020
Practice Address - Fax:631-421-5991
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY134494207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW91571Medicaid
110052703OtherRAILROAD MEDICARE
NY73A031Medicare UPIN
NYW91571Medicaid