Provider Demographics
NPI:1366703464
Name:EZOR, STACY (MS ED)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:EZOR
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 SPRUCE ST
Mailing Address - Street 2:WEST HEMPSTEAD
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2407
Mailing Address - Country:US
Mailing Address - Phone:516-485-0387
Mailing Address - Fax:
Practice Address - Street 1:234 SPRUCE ST
Practice Address - Street 2:WEST HEMPSTEAD
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2407
Practice Address - Country:US
Practice Address - Phone:516-485-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY434937101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist