Provider Demographics
NPI:1790181261
Name:GIZA, MARZENNA JULIA
Entity Type:Individual
Prefix:
First Name:MARZENNA
Middle Name:JULIA
Last Name:GIZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5428
Mailing Address - Country:US
Mailing Address - Phone:917-207-1681
Mailing Address - Fax:
Practice Address - Street 1:8410 60TH AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5428
Practice Address - Country:US
Practice Address - Phone:917-207-1681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY832061141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist