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General NPI Number Information
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NPI Number | 1558735035
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Entity Type | Individual
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Provider Name | MR. STEVE BAZELAIS
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Gender | Male
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 16814 127TH AVE APT 3D
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City | JAMAICA
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State | NY
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Zip | 11434-3113
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Country | US
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Telephone | 347-353-7572
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Fax |
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Provider Business Mailing Address
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Address Line | 16814 127TH AVE APT 3D
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City | JAMAICA
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State | NY
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Zip | 11434-3113
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Country | US
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Telephone | 347-353-7572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 323848-1
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License Number State | NY
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