Provider Demographics
NPI:1497826606
Name:GLEN COVE FAMILY MEDICINE. PLLC
Entity Type:Organization
Organization Name:GLEN COVE FAMILY MEDICINE. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-671-1351
Mailing Address - Street 1:70 GLEN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2855
Mailing Address - Country:US
Mailing Address - Phone:516-671-1351
Mailing Address - Fax:
Practice Address - Street 1:29 GLEN COVE AVE
Practice Address - Street 2:108
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2831
Practice Address - Country:US
Practice Address - Phone:516-671-1351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWBW081Medicare PIN