Healthcare Provider Details

I. General information

NPI: 1326202805
Provider Name (Legal Business Name): VICTOR AZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

V. Phone/Fax

Practice location:
  • Phone: 516-305-5531
  • Fax: 718-470-1821
Mailing address:
  • Phone: 516-305-5531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number244163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: