Provider Demographics
NPI:1336862358
Name:PIZZO, RUSSELL JR
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:PIZZO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DOLLY LN
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2336
Mailing Address - Country:US
Mailing Address - Phone:267-970-6636
Mailing Address - Fax:
Practice Address - Street 1:100 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6196
Practice Address - Country:US
Practice Address - Phone:267-970-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN599281OtherRN LICENSE NUMBER