Healthcare Provider Details

I. General information

NPI: 1649927948
Provider Name (Legal Business Name): MIZIZI-GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 NEW PITTSBURG AVE
DUNDALK MD
21222-6206
US

IV. Provider business mailing address

552 NEW PITTSBURG AVE
DUNDALK MD
21222-6206
US

V. Phone/Fax

Practice location:
  • Phone: 443-807-4271
  • Fax:
Mailing address:
  • Phone: 443-807-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL A YOUNG I
Title or Position: CEO
Credential: RRT
Phone: 443-673-9580