Roosevelt Hazzard, D.P.M

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

N005145 Issued in NY

Practice address

9703 Springfield Blvd
Queens Village, NY 11429-1328

Phone

(718) 465-7200

Fax

(718) 465-0407

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861502403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22102 100TH DR",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291638",
            "telephone_number": "718-217-3762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9703 SPRINGFIELD BLVD",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291328",
            "telephone_number": "718-465-7200",
            "fax_number": "718-465-0407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZZARD",
        "first_name": "ROOSEVELT",
        "name_prefix": "Dr.",
        "credential": "D.P.M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "N005145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01578830",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cindy Harryram, NP
• Jenelle Hartley, ED.M
• Keneisha Haughton
• Kadian Haye-Odipo, LMSW
• Shenike Hayes, OT
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• Heavenly Creations Adult Day Care LLC

• Foot Surgery Podiatrist in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Foot Surgery Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.