Provider Demographics
NPI:1790344349
Name:PIZZITOLA, KAREN (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PIZZITOLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:PIZZITOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2311 BERLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3206
Mailing Address - Country:US
Mailing Address - Phone:860-667-0921
Mailing Address - Fax:860-665-7550
Practice Address - Street 1:2311 BERLIN TPKE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3206
Practice Address - Country:US
Practice Address - Phone:860-667-0921
Practice Address - Fax:860-665-7550
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT816156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1780248344Medicaid