Healthcare Provider Details

I. General information

NPI: 1780771345
Provider Name (Legal Business Name): SAMAR YAZIGI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 2ND AVE PEDIATRICS
BROOKLYN NY
11220-3599
US

IV. Provider business mailing address

5610 2ND AVE PEDIATRICS
BROOKLYN NY
11220-3599
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7499
  • Fax: 718-630-6877
Mailing address:
  • Phone: 718-630-7499
  • Fax: 718-630-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number217970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: