Healthcare Provider Details

I. General information

NPI: 1558413138
Provider Name (Legal Business Name): AZARIAH ESHKENAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114-06 QUEENS BOULEVARD FOREST HILLS SUITE A-1
NYC NY
11375
US

IV. Provider business mailing address

114-06 QUEENS BOULEVARD FOREST HILLS SUITE A-1
NYC NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-793-0505
  • Fax: 718-261-4983
Mailing address:
  • Phone: 718-793-0505
  • Fax: 718-261-4983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1285431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: