Provider Demographics
NPI:1649927948
Name:MIZIZI-GROUP
Entity type:Organization
Organization Name:MIZIZI-GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:I
Authorized Official - Credentials:RRT
Authorized Official - Phone:443-673-9580
Mailing Address - Street 1:552 NEW PITTSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-6206
Mailing Address - Country:US
Mailing Address - Phone:443-807-4271
Mailing Address - Fax:
Practice Address - Street 1:552 NEW PITTSBURG AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-6206
Practice Address - Country:US
Practice Address - Phone:443-807-4271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)