Basic Information
| Provider Information | |||||||||
| NPI: | 1952590424 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSEPH A. IZZI M.D., INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 SMITH ST | ||||||||
| Address2: | |||||||||
| City: | NORTH PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029113340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013535550 | ||||||||
| FaxNumber: | 4013532909 | ||||||||
| Practice Location | |||||||||
| Address1: | 1351 SMITH ST | ||||||||
| Address2: | |||||||||
| City: | NORTH PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029113340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013535550 | ||||||||
| FaxNumber: | 4013532909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | IZZI | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | ORTHOPAEDIC SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 4013535550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 3690 | RI | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 001100 | 01 | RI | BLUE CHIP | OTHER | 09-00203 | 01 | RI | UNITED HEALTH | OTHER | 0000002052 | 01 | RI | BLUE CROSS | OTHER | 3690 | 01 | RI | STATE LICENSE | OTHER |