=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205450996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEXES HAZEN MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2020
-----------------------------------------------------
Last Update Date | 05/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 E 66TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-301-6563
-----------------------------------------------------
Fax | 347-402-8652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 E 66TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-301-6563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALEXES HAZEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-301-6563
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------