NPIMap

Individual provider Active NPI

Nelly Yacoub Kazzaz, MD

  • Cardiovascular Disease Physician
  • Liverpool, NY
National Provider Identifier
1760470900
Registry record updated Oct 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
254476 Issued in NY
Practice address
4820 W Taft Rd
Suite 201
Liverpool, NY 13088-2800
Phone
(315) 234-0906
Fax
(315) 234-4416
NPI assigned
Oct 12, 2005
Last updated
Oct 14, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 254476 NY Primary

Addresses

Primary practice location

4820 W Taft Rd
Suite 201
Liverpool, NY 13088-2800

Mailing address

4820 W Taft Rd
Suite 201
Liverpool, NY 13088-2800
Phone (315) 234-0906

Other identifiers 1

IdentifierTypeStateIssuer
208409001OtherILMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041230000551 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9739147166 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Crouse Medical Practice PLLCGroup PAC ID 8426189622, 187 clinicians

Practice addresses (Care Compare)

4820 W Taft Rd
Suite 209
Liverpool, NY 13088-2806
Phone (315) 448-6215

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
002304NYMDMidwife

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Pathology, PC Current Accepting new patients
Crouse Medical Practice PLLC CurrentSince Aug 1, 2024 Accepting new patients
St Josephs Hospital Health Center CurrentSince Sep 3, 2013 Accepting new patients
St Joseph's Hospital Health Center CurrentSince Sep 3, 2013 Accepting new patients
Cardiovascular Specialists of Central New York PLLC Cardiovascular Disease CurrentSince Sep 9, 2023 Accepting new patients
Crouse Medical Practice, PLLC CurrentSince Aug 1, 2024 Accepting new patients
St Josephs Medical PC CurrentSince Jul 1, 2018 Accepting new patients
North Medical PC Current Accepting new patients
Vijay M. Haryani, MD, SC Cardiovascular Disease PastSince Nov 11, 2003 Accepting new patients
Little Rock Cardiology Clinic, PA Cardiovascular Disease Past Accepting new patients

Locations

4820 W Taft Rd
Ste 201
Liverpool, NY 13088
Phone (315) 234-0906

4820 W Taft Rd
Ste 209
Liverpool, NY 13088
Phone (315) 448-6125

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

110 W 6th St
Oswego, NY 13126
Phone (315) 349-5511

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

Interoperability endpoints

  • Direct secure messaging: nkazzaz@crousemed.medentdirect.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381708800000",
    "number": "1760470900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4820 W TAFT RD",
            "address_2": "SUITE 201",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130882800",
            "telephone_number": "315-234-0906",
            "fax_number": "315-234-4416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4820 W TAFT RD",
            "address_2": "SUITE 201",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130882800",
            "telephone_number": "315-234-0906",
            "fax_number": "315-234-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAZZAZ",
        "first_name": "NELLY",
        "middle_name": "YACOUB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-12",
        "last_updated": "2013-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "254476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "208409001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.