Basic Information
| Provider Information | |||||||||
| NPI: | 1891097317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IZZO | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 RXR PLZ FL 13 | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115561301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164530435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5600 SUNRISE HWY | ||||||||
| Address2: | |||||||||
| City: | SAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117821017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315637828 | ||||||||
| FaxNumber: | 6315637837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2010 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 014385 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 146D00000X | 014385 | NY | N | Emergency Medical Service Providers | Personal Emergency Response Attendant |
No ID Information.