Provider Demographics
NPI:1043608862
Name:RIZZO, JACLYN (PA)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:RIZZO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:656 N.WELLWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-225-4227
Practice Address - Fax:631-225-4229
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2019-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY018226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant