Provider Demographics
NPI:1962646141
Name:BIZER, LARRY STANLEY (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:STANLEY
Last Name:BIZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:BIZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:362 BIRCH LANE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2322
Mailing Address - Country:US
Mailing Address - Phone:914-591-6862
Mailing Address - Fax:914-231-7234
Practice Address - Street 1:362 BIRCH LANE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-2322
Practice Address - Country:US
Practice Address - Phone:914-591-6862
Practice Address - Fax:914-231-7234
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133489208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A55588Medicare UPIN
354213Medicare PIN