MEDICARE: DR. JASON RIZZO 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	207N00000X	Dermatology Physician	296429-1	NY
2	207ND0101X	MOHS-Micrographic Surgery Physician	296429-1	NY

General Provider Information

NPI Number	:	1124446554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON RIZZO M.D.

Provider Business Mailing Address
First Line	:	295 SPINDRIFT DR
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-4701
Country	:	US
Telephone Number	:	716-831-2600
Fax Number	:	716-831-2601

Provider Business Practice Location Address
First Line	:	23471 WALDEN CENTER DR STE 300
Second Line	:
City	:	ESTERO
State	:	FL
Zip	:	34134-5016
Country	:	US
Telephone Number	:	239-498-3376
Fax Number	:	239-498-3379

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

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	08/08/2024

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