Provider Demographics
NPI:1154534865
Name:MORZAK HEALTH CARE SERVICES CSP
Entity type:Organization
Organization Name:MORZAK HEALTH CARE SERVICES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KHADIJAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-769-4034
Mailing Address - Street 1:P.O. BOX 9021
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-0000
Mailing Address - Country:US
Mailing Address - Phone:787-769-4034
Mailing Address - Fax:787-768-8565
Practice Address - Street 1:VALLE ARRIBA HEIGHTS
Practice Address - Street 2:AVE. FIDALGO DIAZ ESQ. AA5
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-0000
Practice Address - Country:US
Practice Address - Phone:787-769-4034
Practice Address - Fax:787-768-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11668208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87784Medicare ID - Type Unspecified