Basic Information
| Provider Information | |||||||||
| NPI: | 1457883753 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JATTALA | ||||||||
| FirstName: | RIZWAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 NEW SCOTLAND AVE | ||||||||
| Address2: | DEPT. OF INTERNAL MEDICINE/PEDIATRICS | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122083412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182627585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47 NEW SCOTLAND AVE | ||||||||
| Address2: | DEPT. OF INTERNAL MEDICINE/PEDIATRICS | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122083412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182627585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2017 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C1-0024333 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | C1-0024333 | DE | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.