| Jack Hazan Llc | |
|
1504 Bay Rd Apt 2003 Miami Beach FL 33139-3277 | |
| (646) 692-0761 | |
| Not Available |
| Full Name | Jack Hazan Llc |
|---|---|
| Speciality | Counselor |
| Location | 1504 Bay Rd Apt 2003, Miami Beach, Florida |
| Authorized Official Name and Position | Jack Hazan (OWNER) |
| Authorized Official Contact | 9174539306 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack Hazan Llc 401 W 25th St Apt 13c New York NY 10001-6575 Ph: (917) 453-9306 | Jack Hazan Llc 1504 Bay Rd Apt 2003 Miami Beach FL 33139-3277 Ph: (646) 692-0761 |
| NPI Number | 1508639279 |
|---|---|
| Provider Enumeration Date | 11/03/2023 |
| Last Update Date | 01/05/2024 |
| Certification Date | 01/05/2024 |
| Medicare PECOS PAC ID | 9739526385 |
|---|---|
| Medicare Enrollment ID | O20240319002435 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508639279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jack Hazan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376022079 PECOS PAC ID: 1052758695 Enrollment ID: I20240319002515 |
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