Basic Information
| Provider Information | |||||||||
| NPI: | 1215662515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EJAZ | ||||||||
| FirstName: | HASHIM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 FERNLEIGH DR APT B10 | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133261323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176694243 | ||||||||
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| Practice Location | |||||||||
| Address1: | MARY IMOGENE BASSETT HOSPITAL | ||||||||
| Address2: | 1 ATWELL ROAD | ||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075473456 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2022 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | 193200000X MULTI-SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.