Provider Demographics
NPI:1396944682
Name:MIZZI, ADAM WALTER (RPA-C)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:WALTER
Last Name:MIZZI
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:5989 BIG TREE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9719
Mailing Address - Country:US
Mailing Address - Phone:585-346-4460
Mailing Address - Fax:585-346-4463
Practice Address - Street 1:5989 BIG TREE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9719
Practice Address - Country:US
Practice Address - Phone:585-346-4460
Practice Address - Fax:585-346-4463
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2008-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY011926-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA2179Medicare PIN