Provider Demographics
NPI:1699511824
Name:PERSITS, AZALIIA (PA)
Entity type:Individual
Prefix:
First Name:AZALIIA
Middle Name:
Last Name:PERSITS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 OCEANA DR E APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6684
Mailing Address - Country:US
Mailing Address - Phone:347-962-7125
Mailing Address - Fax:
Practice Address - Street 1:155 OCEANA DR E APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6684
Practice Address - Country:US
Practice Address - Phone:347-962-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032630-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant