Provider Demographics
NPI:1023587417
Name:LEIZEROWSKI, RAIZY (PA)
Entity type:Individual
Prefix:
First Name:RAIZY
Middle Name:
Last Name:LEIZEROWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6403
Mailing Address - Country:US
Mailing Address - Phone:718-375-1736
Mailing Address - Fax:
Practice Address - Street 1:1436 E 8TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6403
Practice Address - Country:US
Practice Address - Phone:718-375-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant