MEDICARE: DR. THOMAS A BIZZARO MD

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	207RC0000X	Cardiovascular Disease Physician	137491	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	53A361	OTHER	BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4338613	OTHER	AETNA

General Provider Information

NPI Number	:	1518955384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A BIZZARO MD

Provider Business Mailing Address
First Line	:	9116 158TH AVE
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3126
Country	:	US
Telephone Number	:	718-738-7732
Fax Number	:	718-835-3166

Provider Business Practice Location Address
First Line	:	9116 158TH AVE
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3126
Country	:	US
Telephone Number	:	718-738-7732
Fax Number	:	718-835-3166

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	02/15/2012

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