Provider Demographics
NPI:1538279476
Name:AL-IZZI, SAWSAN H (MD)
Entity Type:Individual
Prefix:
First Name:SAWSAN
Middle Name:H
Last Name:AL-IZZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 LENZIE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6010
Mailing Address - Country:US
Mailing Address - Phone:646-641-1792
Mailing Address - Fax:718-250-6678
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:THE BROOKLYN HOSPITAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8000
Practice Address - Fax:718-250-6678
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243614Medicaid