Provider Demographics
NPI:1598011256
Name:RIZZO, JENNIFER (MSED)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:RIZZO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:NOVARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4306 247TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1643
Mailing Address - Country:US
Mailing Address - Phone:718-423-5994
Mailing Address - Fax:
Practice Address - Street 1:4306 247TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11363-1643
Practice Address - Country:US
Practice Address - Phone:718-423-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist