Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 296429-1 | NY |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 296429-1 | NY |
NPI | 1124446554 |
---|---|
Provider Name | Dr. Jason Rizzo |
First Address | Williamsville, NY 14221-4701 |
Second Address | Williamsville, NY 14221-1422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 28/09/2021 |