Healthcare Provider Details

I. General information

NPI: 1750541645
Provider Name (Legal Business Name): RADFAN M GAZALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 KINGS HWY
BROOKLYN NY
11234-2625
US

IV. Provider business mailing address

3201 KINGS HWY
BROOKLYN NY
11234-2625
US

V. Phone/Fax

Practice location:
  • Phone: 718-252-3000
  • Fax:
Mailing address:
  • Phone: 212-252-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number257658
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number257658
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: