Provider Demographics
NPI:1003948472
Name:RIZZO, ROBERT J JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:RIZZO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 PORTION RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-4205
Mailing Address - Country:US
Mailing Address - Phone:631-467-8382
Mailing Address - Fax:631-467-0219
Practice Address - Street 1:1075 PORTION RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-4205
Practice Address - Country:US
Practice Address - Phone:631-467-8382
Practice Address - Fax:631-467-0219
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0097811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C097818OtherNYS WORKERS COMP
C097818OtherNYS WORKERS COMP
U82523Medicare UPIN