Provider Demographics
NPI:1245396001
Name:IZZO, LENNY D (DC)
Entity type:Individual
Prefix:DR
First Name:LENNY
Middle Name:D
Last Name:IZZO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2993
Mailing Address - Country:US
Mailing Address - Phone:631-547-5433
Mailing Address - Fax:631-547-5434
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2993
Practice Address - Country:US
Practice Address - Phone:631-547-5433
Practice Address - Fax:631-547-5434
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002514-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX14381Medicare UPIN