Provider Demographics
NPI:1386248235
Name:IOZZINO, ELIZABETH (RD, CDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:IOZZINO
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FOX RD
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1005
Mailing Address - Country:US
Mailing Address - Phone:845-269-8629
Mailing Address - Fax:
Practice Address - Street 1:1 FOX RD
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-1005
Practice Address - Country:US
Practice Address - Phone:845-269-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010379-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty