Provider Demographics
NPI:1154558575
Name:IOCOVOZZI, GERALYN M
Entity type:Individual
Prefix:MS
First Name:GERALYN
Middle Name:M
Last Name:IOCOVOZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MARY ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1922
Mailing Address - Country:US
Mailing Address - Phone:315-440-5598
Mailing Address - Fax:
Practice Address - Street 1:126 MARY ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1922
Practice Address - Country:US
Practice Address - Phone:315-440-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004407-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004407-1OtherLICENSE NUMBER