Provider Demographics
NPI:1437528171
Name:FLIZE ANNEVO BRYAN
Entity Type:Organization
Organization Name:FLIZE ANNEVO BRYAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:FLIZE
Authorized Official - Middle Name:ANNEVO
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-434-5988
Mailing Address - Street 1:721 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1103
Mailing Address - Country:US
Mailing Address - Phone:718-434-5988
Mailing Address - Fax:718-434-5988
Practice Address - Street 1:721 E 22ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1103
Practice Address - Country:US
Practice Address - Phone:718-434-5988
Practice Address - Fax:718-434-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129936261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care