Healthcare Provider Details

I. General information

NPI: 1619586419
Provider Name (Legal Business Name): KAZBAY MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SALIERNO RD
TUXEDO PARK NY
10987-4712
US

IV. Provider business mailing address

83 SALIERNO RD
TUXEDO PARK NY
10987-4712
US

V. Phone/Fax

Practice location:
  • Phone: 646-745-4150
  • Fax:
Mailing address:
  • Phone: 646-745-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEVEN SMITH
Title or Position: MANAGER
Credential:
Phone: 502-244-9859