Healthcare Provider Details

I. General information

NPI: 1538080544
Provider Name (Legal Business Name): BRYANT IZURIETA PA-C, R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3198
US

IV. Provider business mailing address

66 TULIP AVE APT 7B
FLORAL PARK NY
11001-1812
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5250
  • Fax:
Mailing address:
  • Phone: 917-703-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: