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General NPI Number Information
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NPI Number | 1306154489
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Entity Type | Individual
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Provider Name | MICHAEL ADAM IZEN D.V.M.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 137 PIERMONT RD
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City | CLOSTER
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State | NJ
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Zip | 07624-1518
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Country | US
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Telephone | 201-768-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 20 NORTHVIEW AVE APT 1
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1809
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Country | US
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Telephone | 201-543-3206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174M00000X
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Taxonomy Name | Veterinarian
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License Number | 29VI00579400
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License Number State | NJ
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