Healthcare Provider Details

I. General information

NPI: 1366417677
Provider Name (Legal Business Name): PAUL CARMINE GAZZARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3589 HYLAN BLVD
STATEN ISLAND NY
10308-3513
US

IV. Provider business mailing address

3589 HYLAN BLVD
STATEN ISLAND NY
10308-3513
US

V. Phone/Fax

Practice location:
  • Phone: 718-966-3700
  • Fax: 718-966-0433
Mailing address:
  • Phone: 718-966-3700
  • Fax: 718-966-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number162022
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number162022
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number25MA08425900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: