Healthcare Provider Details

I. General information

NPI: 1306126651
Provider Name (Legal Business Name): MAUREEN N EZIUZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 120343
SAINT ALBANS NY
11412-0343
US

IV. Provider business mailing address

PO BOX 120343
SAINT ALBANS NY
11412-0343
US

V. Phone/Fax

Practice location:
  • Phone: 516-321-0258
  • Fax:
Mailing address:
  • Phone: 516-321-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF407727
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number643664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: