1881644631 NPI number — MISS SUSAN CHARMAINE IZZO N.P.

Table of content: MISS SUSAN CHARMAINE IZZO N.P. (NPI 1881644631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881644631 NPI number — MISS SUSAN CHARMAINE IZZO N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IZZO
Provider First Name:
SUSAN
Provider Middle Name:
CHARMAINE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CZARNECKI
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881644631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 NAEK RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
VERNON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06066-3942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-872-2289
Provider Business Mailing Address Fax Number:
860-896-1425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 HARTFORD TPKE
Provider Second Line Business Practice Location Address:
SUITE N
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06066-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-872-8321
Provider Business Practice Location Address Fax Number:
860-875-6271
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  003300 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 003300 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004261062 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com