MEDICARE: DR. JAMES CRISTOPHER IZZANO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	285481	NY

General Provider Information

NPI Number	:	1033475215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES CRISTOPHER IZZANO M.D.

Provider Business Mailing Address
First Line	:	700 S PERRY ST
Second Line	:	JOHNSTOWN OB/GYN HEALTH CENTER
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3213
Country	:	US
Telephone Number	:	518-736-1004
Fax Number	:	518-762-8829

Provider Business Practice Location Address
First Line	:	700 S PERRY ST
Second Line	:	JOHNSTOWN OB/GYN HEALTH CENTER
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3213
Country	:	US
Telephone Number	:	518-736-1004
Fax Number	:	518-762-8829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	07/21/2022

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