Provider Demographics
NPI:1164995668
Name:WISZOWATY, TERESA ELISABETH
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ELISABETH
Last Name:WISZOWATY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:RIZZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:61 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3102
Mailing Address - Country:US
Mailing Address - Phone:347-468-6520
Mailing Address - Fax:
Practice Address - Street 1:61 BEECH ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3102
Practice Address - Country:US
Practice Address - Phone:347-468-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency