Healthcare Provider Details

I. General information

NPI: 1124559497
Provider Name (Legal Business Name): MIRA YAZIGI CHALET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRA YAZIGI M.D.

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 SUMMIT AVE
HACKENSACK NJ
07601-1311
US

IV. Provider business mailing address

32 WEAVER ST
LITTLE FALLS NJ
07424-1046
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-8222
  • Fax: 201-487-2126
Mailing address:
  • Phone: 973-452-5085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10833700
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: