Provider Demographics
NPI:1366417677
Name:GAZZARA, PAUL CARMINE (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CARMINE
Last Name:GAZZARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3589 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3513
Mailing Address - Country:US
Mailing Address - Phone:718-966-3700
Mailing Address - Fax:718-966-0433
Practice Address - Street 1:3589 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3513
Practice Address - Country:US
Practice Address - Phone:718-966-3700
Practice Address - Fax:718-966-0433
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162022207R00000X, 174400000X
NJ25MA08425900207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBG0450813OtherDEA #
NY69D631Medicare ID - Type Unspecified
NYA63840Medicare UPIN