Healthcare Provider Details

I. General information

NPI: 1063020063
Provider Name (Legal Business Name): GAGE AZEEZ FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SANDERSON ST
GREENFIELD MA
01301-2778
US

IV. Provider business mailing address

46 TIMBER LN
SPRINGFIELD MA
01119-2828
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-2022
  • Fax: 413-773-4945
Mailing address:
  • Phone: 413-364-4607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2296511
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: