Provider Demographics
NPI:1588116784
Name:IZZO MEDICAL PC
Entity type:Organization
Organization Name:IZZO MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-633-3505
Mailing Address - Street 1:144-20 79 STREET
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2911
Mailing Address - Country:US
Mailing Address - Phone:347-633-3505
Mailing Address - Fax:
Practice Address - Street 1:144-60 89 STREET
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2911
Practice Address - Country:US
Practice Address - Phone:347-633-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2157371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty