MEDICARE: KATHLEEN PIROZZI APN, NP-C

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	26NO11355700	NJ
2	363LA2200X	Adult Health Nurse Practitioner	26NJ00336000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26NJ00336000	OTHER	NJ	APN LICENSE NUMBER

General Provider Information

NPI Number	:	1649564568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN PIROZZI APN, NP-C

Provider Business Mailing Address
First Line	:	316 VAN EMBURGH AVENUE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-9998
Country	:	US
Telephone Number	:	201-446-5130
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 VAN EMBURGH AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-9998
Country	:	US
Telephone Number	:	201-446-5130
Fax Number	:

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

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	06/23/2011

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