MEDICARE: ALIZZA RETTER PA-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	363A00000X	Physician Assistant	017378	NY
2	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972913051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIZZA RETTER PA-C

Provider Business Mailing Address
First Line	:	620 FOSTER AVE STE 200
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1399
Country	:	US
Telephone Number	:	718-407-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4514 16TH AVE FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1101
Country	:	US
Telephone Number	:	718-407-7300
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	01/12/2021

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Directions to “ ALIZZA RETTER PA-C” Practice Location

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