Individual
NELLY YACOUB KAZZAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4820 W TAFT RD, SUITE 201, LIVERPOOL, NY 13088-2800
(315) 234-0906
(315) 234-4416
Mailing address
4820 W TAFT RD, SUITE 201, LIVERPOOL, NY 13088-2800
(315) 234-0906
(315) 234-4416
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
254476
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208409001
MEDICARE PTAN
IL
Enumeration date
10/12/2005
Last updated
10/14/2013
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