Provider Demographics
NPI:1982203402
Name:PAULINE IZZO, NURSE PRACTITIONER IN FAMILY HEALTH PC
Entity Type:Organization
Organization Name:PAULINE IZZO, NURSE PRACTITIONER IN FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-737-8717
Mailing Address - Street 1:544 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2233
Mailing Address - Country:US
Mailing Address - Phone:718-737-8717
Mailing Address - Fax:
Practice Address - Street 1:544 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2233
Practice Address - Country:US
Practice Address - Phone:718-737-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty