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Individual

DR. ROOSEVELT HAZZARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M

Contact information

Practice address
9703 SPRINGFIELD BLVD, QUEENS VILLAGE, NY 11429-1328
(718) 465-7200
(718) 465-0407
Mailing address
22102 100TH DR, QUEENS VILLAGE, NY 11429-1638
(718) 217-3762

Taxonomy

Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
N005145
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01578830
NY
Enumeration date
08/30/2006
Last updated
07/08/2007
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