Provider Demographics
NPI:1699133769
Name:FEDRIZZI, JOSEPH JR
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FEDRIZZI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4653 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIDDLESEX
Mailing Address - State:PA
Mailing Address - Zip Code:16159-4407
Mailing Address - Country:US
Mailing Address - Phone:724-301-3356
Mailing Address - Fax:
Practice Address - Street 1:4653 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:WEST MIDDLESEX
Practice Address - State:PA
Practice Address - Zip Code:16159-4407
Practice Address - Country:US
Practice Address - Phone:724-301-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN276548164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse