Provider Demographics
NPI:1851660310
Name:EIVAZI, JOANNA (MSED)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:EIVAZI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:WEITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:3812 DIANNE ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5405
Mailing Address - Country:US
Mailing Address - Phone:516-749-2190
Mailing Address - Fax:516-336-5589
Practice Address - Street 1:300 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 350
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3302
Practice Address - Country:US
Practice Address - Phone:516-747-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY701381252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency