Healthcare Provider Details

I. General information

NPI: 1366722803
Provider Name (Legal Business Name): BAZHENA FIDMAN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 08/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CHRISTOPHER ST
NEW YORK NY
10014-4236
US

IV. Provider business mailing address

139 HYLAN BLVD FL2
STATEN ISLAND NY
10305-2005
US

V. Phone/Fax

Practice location:
  • Phone: 212-627-2662
  • Fax: 212-627-4782
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number055954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: