Provider Demographics
NPI:1912915620
Name:SMIZZI, JOSEPH F (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:SMIZZI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2212 PENFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1756
Practice Address - Country:US
Practice Address - Phone:585-598-8567
Practice Address - Fax:585-388-1483
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007341-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02564914Medicaid
NY02564914Medicaid