Provider Demographics
NPI:1316450240
Name:RIZZUTO, LISA (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RIZZUTO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1500 ROUTE 112 BLDG 4
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8054
Mailing Address - Country:US
Mailing Address - Phone:631-751-3000
Mailing Address - Fax:631-509-6559
Practice Address - Street 1:235 N BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3456
Practice Address - Country:US
Practice Address - Phone:631-751-3000
Practice Address - Fax:631-509-6559
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant