Provider Demographics
NPI:1164569943
Name:ILLUZZI, FRANK ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:ANTHONY
Last Name:ILLUZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 RXR PLZ
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:516-783-4600
Mailing Address - Fax:
Practice Address - Street 1:256 E ROUTE 59
Practice Address - Street 2:BUILDING A
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2905
Practice Address - Country:US
Practice Address - Phone:516-783-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040470207P00000X
NY219399207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H78229Medicare UPIN
CT990000893Medicare PIN