Provider Demographics
NPI:1427635291
Name:RIZZI, LAURA A (PA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:RIZZI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:MASEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 HERZEL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3715
Mailing Address - Country:US
Mailing Address - Phone:516-507-0729
Mailing Address - Fax:
Practice Address - Street 1:986 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6111
Practice Address - Country:US
Practice Address - Phone:631-587-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026493363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant