Individual
DIANA KAZAKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9209 JAMAICA AVE, WOODHAVEN, NY 11421-2108
(917) 300-7225
Mailing address
188 FOREST ST, ROSLYN HEIGHTS, NY 11577-1241
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
353692
NY
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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