Basic Information
| Provider Information | |||||||||
| NPI: | 1134128523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IZBICKI | ||||||||
| FirstName: | JONATHON | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 717 STATE STREET, SUITE 16, LL | ||||||||
| Address2: | IZBICKI FAMILY MEDICINE, PC | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777100 | ||||||||
| FaxNumber: | 8148772939 | ||||||||
| Practice Location | |||||||||
| Address1: | 3424 PEACH ST. | ||||||||
| Address2: | IZBICKI FAMILY MEDICINE, PC | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144616626 | ||||||||
| FaxNumber: | 8148716349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 03/19/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | PA 05013096 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS013096 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.