Provider Demographics
NPI:1598843427
Name:PIZZOLLA, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PIZZOLLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 165TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1443
Mailing Address - Country:US
Mailing Address - Phone:718-461-2299
Mailing Address - Fax:
Practice Address - Street 1:4207 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2735
Practice Address - Country:US
Practice Address - Phone:718-463-1661
Practice Address - Fax:718-463-3716
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01097850Medicaid
NY01097850Medicaid
NYB58704Medicare UPIN