Individual
MRS. ANISA MS HAZELWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
100 DIXON AVE, COPIAGUE, NY 11726-1905
(631) 491-1278
Mailing address
100 DIXON AVE, COPIAGUE, NY 11726-1905
(631) 491-1278
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
846148141
NY
174400000X
Specialist
846149141
NY
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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