Provider Demographics
NPI:1285015487
Name:RIZKALA, AMIR REMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:REMOND
Last Name:RIZKALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17625 UNION TPKE
Mailing Address - Street 2:PO BOX: 425
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5621 189TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2232
Practice Address - Country:US
Practice Address - Phone:718-216-3402
Practice Address - Fax:984-203-6372
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306500-01208100000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program