Healthcare Provider Details

I. General information

NPI: 1336165992
Provider Name (Legal Business Name): TAMARA DRAZIN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

3671 HUDSON MANOR TER APT 6A
BRONX NY
10463-1138
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-5259
  • Fax:
Mailing address:
  • Phone: 347-427-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT-005653-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierT005653-1
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOPTOMETRIC LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: